Symptoms of Autonomic Dysfunction in Pediatric Headache

hands nervous
hands nervous
Cold and clammy hands and feet were common among pediatric patients with tension-type headache.

Symptoms of autonomic dysfunction are common in pediatric patients with migraine and tension-type headache, according to research published in the journal Clinical Autonomic Research.1

While autonomic dysfunction has been documented in adult migraine,2,3 few studies have evaluated symptoms in other migraine diagnoses and pediatric patients. In this study, researchers sought to compare the frequency of symptoms of autonomic dysfunction in pediatric patients with migraine and tension-type headache with a control group of patients with idiopathic scoliosis – a diagnosis that rarely presents with symptoms of autonomic dysfunction.

The researchers, led by Jonathan Rabner, of Boston Children’s Hospital in Massachusetts, conducted a retrospective chart review of pediatric headache patients between 2009 and 2013. Patients diagnosed with disorders with known autonomic involvement were excluded. Autonomic dysfunction was evaluated through an adapted version of the COMPASS-31 questionnaire, which assessed constipation, insomnia, dizziness, blurry vision, abnormal blood pressure, and cold and clammy palms and soles.

The analysis ultimately included 125 patients with headache: 68 with migraine (mean age= 13.1 years; 46% female) and 57 with tension-type headache (mean age= 14.7 years; 70% female), and 106 patients with idiopathic scoliosis in the control group (mean age= 12.6 years; 69% female). Strong associations were observed for cold and clammy palms and soles, while moderate associations were observed for insomnia and dizziness among the headache groups.

The frequency of symptoms across all 6 domains was greater in the tension-type headache group than the migraine group; however the frequency of cold and clammy palms and soles was the only symptom that showed a significant difference in the tension-type headache group (68%) vs the migraine group (38%; P <.001).

When compared with the control group, significant differences in symptom frequency among the tension-type and migraine headache groups were observed for insomnia (P <.001), dizziness (P <.001), and cold and clammy palms and soles (P =.001).

“One possible explanation for the increased reports of ‘cold and clammy palms and soles’ in the headache groups is increased sympathetic hyperfunction,” the authors wrote. “Increased sympathetic discharge found in headache patients may activate the small nerve fibers connected to sweat glands to cause excessive sweating.”

While noting several study limitations, including the retrospective nature of the study, as well as an imperfect control group, the researchers concluded that the results highlight the need for better assessment of autonomic symptoms in pediatric headache patients, as an improved understanding may help shed light on the underlying mechanisms of pediatric headache – especially tension-type – and improve accuracy of diagnosis and treatment.


  1. Rabner J, Caruso A, Zurakowski D, Lazdowsky L, LeBel A. Autonomic dysfunction in pediatric patients with headache: migraine versus tension-type headache. Clin Auton Res. 2016;26:455-459.
  2. Shechter A, Stewart WF, Silberstein SD, Lipton RB. Migraine and autonomic nervous system function a population based, case-control study. Neurology. 2002;58:422–427. doi:10.1212/WNL.58.3.4224.
  3. Yerdelen D, Acil T, Goksel B, Karatas M. Heart rate recovery in migraine and tension-type headache. Headache. 2008;48:221–225. doi:10.1111/j.1526-4610.2007.00994.