Migraine Symptoms: Central Autonomic Parasympathetic Symptoms

Written by Jessica Puterbaugh | May 31, 2022

Many people with migraine experience what are collectively known as central autonomic parasympathetic symptoms. This unique set of symptoms are often not recognized as being part of migraine, which frequently leads to misdiagnosis or even inappropriate treatments.

What is interesting for people with migraine, is that although these symptoms are underrecognized, they are actually fairly prevalent. Because of this, learning to recognize them may help guide diagnosis, provide insight into treatment options, and help us better understand the overarching burden of migraine disease.

What are central autonomic parasympathetic symptoms?

According to the National Headache Foundation, 45% of people with migraine experience at least one autonomic symptom due to increased activity in nerve tissues triggered by migraine mechanisms. These symptoms may include:

  • Watery, teary eyes
  • Droopy eyes
  • Puffy eyes
  • Scratchy or dry eyes
  • Bloodshot eyes
  • Runny nose
  • Nasal congestion
  • Ear pain
  • Ear fullness
  • Facial flushing

These symptoms often lead to congestion and pressure, which can make head pain more severe during a migraine attack and make you feel generally quite lousy. In addition to their presence as part of migraine itself, seasonal and weather changes may also intensify these symptoms, compounding their impact.

While people with migraine often experience these autonomic symptoms, they are also common for those with cluster headache, as well as overlapping with many other conditions. As a result, people may be told they have sinus headaches, colds and/or allergies, or even cluster headache, when in fact it is migraine that is the culprit. (Learn more about ways to know the difference between migraine and cluster headache here.) These symptoms can also be signs of other conditions such as Sjogrens syndrome, rheumatoid arthritis, Bell’s palsy, dry eye syndrome, blepharitis, thyroid disorders, conjunctivitis and other eye infections. For some people it may take visits to multiple specialists over a period of time to determine what is actually going on, which can be challenging and frustrating for patients living with these symptoms.

Managing autonomic symptoms

Autonomic symptoms can be quite frustrating and draining to deal with, especially if you are not diagnosed properly or diagnosis takes longer than hoped for. If you experience these symptoms, discuss them with your doctor so that you can figure out the best treatment options for managing them. Some other things that may help include:

  • Tracking your symptoms in a migraine app or journal
  • Maintaining a healthy lifestyle through exercise, sleep, and diet
  • Avoiding your usual migraine triggers
  • Trying a medical device for migraine
  • Trying OTC treatment options such as heat/ice packs

Tell us! Did you know these types of symptoms were related to migraine? If you experience any of them, what tips can you share for how to manage, and did your doctor recognize these as part of migraine?

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