Low frequency activation of the sphenopalatine ganglion does not induce migraine-like attacks in migraine patients
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Low frequency activation of the sphenopalatine ganglion does not induce migraine-like attacks in migraine patients. / Guo, Song; Falkenberg, Katrine; Schytz, Henrik Winther; Caparso, Anthony; Jensen, Rigmor Højland; Ashina, Messoud.
In: Cephalalgia, Vol. 40, No. 9, 2020, p. 966-977.Research output: Contribution to journal › Journal article › Research › peer-review
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T1 - Low frequency activation of the sphenopalatine ganglion does not induce migraine-like attacks in migraine patients
AU - Guo, Song
AU - Falkenberg, Katrine
AU - Schytz, Henrik Winther
AU - Caparso, Anthony
AU - Jensen, Rigmor Højland
AU - Ashina, Messoud
PY - 2020
Y1 - 2020
N2 - Introduction: Cephalic autonomic symptoms occur in 27‒73% of migraine patients during attacks. The role of parasympathetic activation in migraine attack initiation remains elusive. Low frequency stimulation of the sphenopalatine ganglion increases parasympathetic outflow. In this study, we hypothesized that low frequency stimulation of the sphenopalatine ganglion would provoke migraine-like attacks in migraine patients. Methods: In a double-blind randomized sham-controlled crossover study, 12 migraine patients with a sphenopalatine ganglion neurostimulator received low frequency or sham stimulation for 30 min on two separate days. We recorded headache characteristics, cephalic autonomic symptoms, ipsilateral mechanical perception and pain thresholds, mean blood flow velocity in the middle cerebral artery (VMCA) and diameter of the superficial temporal artery during and after stimulation. Results: Five patients (42%) reported a migraine-like attack after low frequency stimulation compared to six patients (50%) after sham (p = 1.000). We found a significant increase in mechanical detection thresholds during low frequency stimulation compared to baseline (p = 0.007). Occurrence of cephalic autonomic symptoms and changes in mechanical perception thresholds, VMCA and diameter of the superficial temporal artery showed no difference between low frequency stimulation compared to sham (p = 0.533). Conclusion: Low frequency stimulation of the sphenopalatine ganglion did not induce migraine-like attacks or autonomic symptoms in migraine patients. These data suggest that increased parasympathetic outflow by the sphenopalatine ganglion neurostimulator does not initiate migraine-like attacks. Study protocol: ClinicalTrials.gov registration number NCT02510742
AB - Introduction: Cephalic autonomic symptoms occur in 27‒73% of migraine patients during attacks. The role of parasympathetic activation in migraine attack initiation remains elusive. Low frequency stimulation of the sphenopalatine ganglion increases parasympathetic outflow. In this study, we hypothesized that low frequency stimulation of the sphenopalatine ganglion would provoke migraine-like attacks in migraine patients. Methods: In a double-blind randomized sham-controlled crossover study, 12 migraine patients with a sphenopalatine ganglion neurostimulator received low frequency or sham stimulation for 30 min on two separate days. We recorded headache characteristics, cephalic autonomic symptoms, ipsilateral mechanical perception and pain thresholds, mean blood flow velocity in the middle cerebral artery (VMCA) and diameter of the superficial temporal artery during and after stimulation. Results: Five patients (42%) reported a migraine-like attack after low frequency stimulation compared to six patients (50%) after sham (p = 1.000). We found a significant increase in mechanical detection thresholds during low frequency stimulation compared to baseline (p = 0.007). Occurrence of cephalic autonomic symptoms and changes in mechanical perception thresholds, VMCA and diameter of the superficial temporal artery showed no difference between low frequency stimulation compared to sham (p = 0.533). Conclusion: Low frequency stimulation of the sphenopalatine ganglion did not induce migraine-like attacks or autonomic symptoms in migraine patients. These data suggest that increased parasympathetic outflow by the sphenopalatine ganglion neurostimulator does not initiate migraine-like attacks. Study protocol: ClinicalTrials.gov registration number NCT02510742
KW - autonomic nervous system
KW - cephalic autonomic symptoms
KW - headache model
KW - Migraine
KW - neurostimulation
KW - sphenopalatine ganglion
U2 - 10.1177/0333102420921156
DO - 10.1177/0333102420921156
M3 - Journal article
C2 - 32321288
AN - SCOPUS:85083796721
VL - 40
SP - 966
EP - 977
JO - Cephalalgia
JF - Cephalalgia
SN - 0800-1952
IS - 9
ER -
ID: 258775108