Objective

The presence of aura is rare in cluster headache, and even rarer in other trigeminal autonomic cephalalgias. We hypothesized that the presence of aura in patients with trigeminal autonomic cephalalgias is frequently an epiphenomenon and mediated by comorbid migraine with aura.

Methods

The study retrospectively reviewed 480 patients with trigeminal autonomic cephalalgia in a tertiary medical center for 10 years. Phenotypes and temporal correlation of aura with headache were analyzed. Trigeminal autonomic cephalalgia patients with aura were further followed up in a structured telephone interview.

Results

Seventeen patients with aura (3.5%) were identified from 480 patients with trigeminal autonomic cephalalgia, including nine with cluster headache, one with paroxysmal hemicrania, three with hemicrania continua, and four with probable trigeminal autonomic cephalalgia. Compared to trigeminal autonomic cephalalgia patients without aura, trigeminal autonomic cephalalgia patients with aura were more likely to have a concomitant diagnosis of migraine with aura (odds ratio [OR] = 109.0, 95% CI 30.9–383.0, p < 0.001); whereas the risk of migraine without aura remains similar between both groups (OR = 1.10, 95% CI = 0.14–8.59, p = 0.931). Aura was more frequently accompanied with migraine-like attacks, but not trigeminal autonomic cephalalgia attacks.

Interpretation

In most patients with trigeminal autonomic cephalalgia, the presence of aura is mediated by the comorbidity of migraine with aura. Aura directly related to trigeminal autonomic cephalalgia attack may exist but remains rare. Our results suggest that aura may not be involved in the pathophysiology of trigeminal autonomic cephalalgia.

中文翻译：

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三叉神经性自主神经性头痛的先兆可能是由先兆合并偏头痛介导的

客观的

先兆在丛集性头痛中很少见，在其他三叉自主神经性头痛中更罕见。我们假设三叉神经自主神经性头痛患者的先兆通常是一种附带现象，并由有先兆的共病偏头痛介导。

方法

该研究回顾性回顾了一家三级医疗中心 10 年的 480 名三叉神经自主神经性头痛患者。分析了先兆与头痛的表型和时间相关性。对有先兆的三叉神经自主神经性脑痛患者进行结构化电话访谈。

结果

从 480 例三叉神经性自主神经性脑痛患者中鉴定出 17 名先兆患者（3.5%），其中丛集性头痛 9 人，阵发性偏头痛 1 人，持续性偏头痛 3 人，可能三叉自主神经性脑痛 4 人。与无先兆的三叉神经自主神经性脑痛患者相比，有先兆的三叉神经自主神经性脑痛患者更可能同时诊断有先兆偏头痛（优势比 [OR] = 109.0, 95% CI 30.9–383.0, p  < 0.001）；而两组之间无先兆偏头痛的风险仍然相似（OR = 1.10, 95% CI = 0.14–8.59, p  = 0.931）。Aura 更常伴有偏头痛样发作，但不伴有三叉神经自主性脑痛发作。

解释

在大多数三叉神经自主神经性头痛患者中，先兆的存在是由先兆偏头痛的共病介导的。可能存在与三叉自主神经性头痛发作直接相关的先兆，但仍然很少见。我们的研究结果表明，先兆可能与三叉神经自主神经性头痛的病理生理学无关。