The autonomic nervous system runs automatic functions like heart rate, blood pressure, digestion and sweating. It has two main branches: “fight or flight” (sympathetic) and “rest and digest” (parasympathetic).

Migraine and autonomic function

• People with migraine show differences in autonomic control, such as uneven blood flow between the two sides of the face ¹.
• Fainting is more common in people with migraine ².
• Autonomic differences are seen during sleep in people with sleep-related migraine ³ and in people with post-traumatic headache ⁴.
• Many migraine symptoms, like nausea, tearing, nasal congestion and pale skin, are autonomic ⁵.

Why it matters

An autonomic system stuck in “fight or flight” adds to the bucket. Dr. Harcourt’s exam includes checks like blood pressure in both arms and responses to position changes. Treatments that target the vagus nerve, the main “rest and digest” nerve, have been studied for migraine. See Neuromodulation devices.

Research cited on this page

1. Zaproudina N, Teplov V, Nippolainen E, et al. Asynchronicity of facial blood perfusion in migraine. PLoS One. 2013;8(12):e80189. PubMed 24324592 · DOI
2. Thijs RD, Kruit MC, van Buchem MA, et al. Syncope in migraine: the population-based CAMERA study. Neurology. 2006;66(7):1034-7. PubMed 16606915 · DOI
3. Vollono C, Gnoni V, Testani E, et al. Heart rate variability in sleep-related migraine without aura. J Clin Sleep Med. 2013;9(7):707-14. PubMed 23853566 · DOI
4. Howard L, Dumkrieger G, Chong CD, et al. Symptoms of Autonomic Dysfunction Among Those With Persistent Posttraumatic Headache Attributed to Mild Traumatic Brain Injury: A Comparison to Migraine and Healthy Controls. Headache. 2018;58(9):1397-1407. PubMed 30156267 · DOI
5. Goadsby PJ, Holland PR, Martins-Oliveira M, et al. Pathophysiology of Migraine: A Disorder of Sensory Processing. Physiol Rev. 2017;97(2):553-622. PubMed 28179394 · DOI