Sphenopalatine ganglion stimulation induces changes in cardiac autonomic regulation in cluster headache
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Sphenopalatine ganglion stimulation induces changes in cardiac autonomic regulation in cluster headache. / Barloese, Mads; Petersen, Anja S; Guo, Song; Ashina, Messoud; Mehlsen, Jesper; Jensen, Rigmor H.
In: Clinical Physiology and Functional Imaging, Vol. 38, No. 5, 2018, p. 808-815.Research output: Contribution to journal › Journal article › Research › peer-review
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TY - JOUR
T1 - Sphenopalatine ganglion stimulation induces changes in cardiac autonomic regulation in cluster headache
AU - Barloese, Mads
AU - Petersen, Anja S
AU - Guo, Song
AU - Ashina, Messoud
AU - Mehlsen, Jesper
AU - Jensen, Rigmor H
N1 - © 2017 Scandinavian Society of Clinical Physiology and Nuclear Medicine. Published by John Wiley & Sons Ltd.
PY - 2018
Y1 - 2018
N2 - INTRODUCTION: Cluster headache is characterized by attacks of severe unilateral pain accompanied by cranial and systemic autonomic changes. Our knowledge of the latter is imperfect. This study aimed to investigate the effect of low-frequency sphenopalatine ganglion stimulation on cardiac autonomic regulation.MATERIALS AND METHODS: In a double-blind, randomized, sham-controlled crossover design, patients received low-frequency and sham stimulation. RR intervals were recorded, and heart rate variability was analysed (time-domain, frequency-domain, nonlinear parameters). Headache characteristics, including cranial autonomic symptoms, were recorded at baseline and every 10 min for 60 min.RESULTS: Sixteen patients were included. Changes in heart rate variability from baseline in the analysed parameters differed significantly between low-frequency and sham stimulation. Initially, during low-frequency stimulation, there was a greater increase in heart rate compared to sham (P<0·05) and changes in the frequency, nonlinear and time domain (P<0·05) reflecting a higher sympathetic tone. These preceded the observed cranial autonomic symptoms. Ten episodes of cluster-like attacks were reported (six following low-frequency stimulation, four following sham). During these, parasympathetic tone (P<0·05) was higher compared to baseline.CONCLUSIONS: In cluster headache patients subjected to low-frequency and sham stimulation of the sphenopalatine ganglion, we found changes indicating higher sympathetic tone during low-frequency stimulation preceding cranial autonomic symptoms or cluster pain. During cluster pain, regardless of stimulation parameters, we saw increased parasympathetic activity, congruent with previous reports. The results indicate involvement of cardiac autonomic regulation before and during cluster headache attacks.
AB - INTRODUCTION: Cluster headache is characterized by attacks of severe unilateral pain accompanied by cranial and systemic autonomic changes. Our knowledge of the latter is imperfect. This study aimed to investigate the effect of low-frequency sphenopalatine ganglion stimulation on cardiac autonomic regulation.MATERIALS AND METHODS: In a double-blind, randomized, sham-controlled crossover design, patients received low-frequency and sham stimulation. RR intervals were recorded, and heart rate variability was analysed (time-domain, frequency-domain, nonlinear parameters). Headache characteristics, including cranial autonomic symptoms, were recorded at baseline and every 10 min for 60 min.RESULTS: Sixteen patients were included. Changes in heart rate variability from baseline in the analysed parameters differed significantly between low-frequency and sham stimulation. Initially, during low-frequency stimulation, there was a greater increase in heart rate compared to sham (P<0·05) and changes in the frequency, nonlinear and time domain (P<0·05) reflecting a higher sympathetic tone. These preceded the observed cranial autonomic symptoms. Ten episodes of cluster-like attacks were reported (six following low-frequency stimulation, four following sham). During these, parasympathetic tone (P<0·05) was higher compared to baseline.CONCLUSIONS: In cluster headache patients subjected to low-frequency and sham stimulation of the sphenopalatine ganglion, we found changes indicating higher sympathetic tone during low-frequency stimulation preceding cranial autonomic symptoms or cluster pain. During cluster pain, regardless of stimulation parameters, we saw increased parasympathetic activity, congruent with previous reports. The results indicate involvement of cardiac autonomic regulation before and during cluster headache attacks.
KW - Adult
KW - Aged
KW - Autonomic Nervous System/physiopathology
KW - Cluster Headache/diagnosis
KW - Cross-Over Studies
KW - Denmark
KW - Double-Blind Method
KW - Electric Stimulation Therapy/adverse effects
KW - Female
KW - Ganglia, Autonomic
KW - Heart/innervation
KW - Heart Rate
KW - Humans
KW - Implantable Neurostimulators
KW - Male
KW - Middle Aged
KW - Nonlinear Dynamics
KW - Pain Measurement
KW - Pterygopalatine Fossa
KW - Time Factors
KW - Treatment Outcome
U2 - 10.1111/cpf.12484
DO - 10.1111/cpf.12484
M3 - Journal article
C2 - 29105279
VL - 38
SP - 808
EP - 815
JO - Clinical Physiology and Functional Imaging
JF - Clinical Physiology and Functional Imaging
SN - 1475-0961
IS - 5
ER -
ID: 216307888