What are cranial autonomic symptoms?

Imagine a headache accompanied by tears from the eyes, a blocked nose, or even facial sweating. At first glance, such symptoms may seem atypical for an ordinary headache, right? These are precisely cranial autonomic symptoms — CAS. They are usually associated with migraines or rare but intense trigeminal autonomic headaches (TACs). Moreover, their nature can resemble symptoms of sinus infections or eye irritation, leading to misdiagnoses.

As Dr. Straburzynski explains, these symptoms may result from the trigeminal-autonomic reflex, which evolved to protect our eyes and noses.

"When something enters the eye or nose, the trigeminal nerve is stimulated, triggering autonomic reactions such as tearing or swelling of the mucous membrane. A similar mechanism may be at work for headaches, including TTH" explains the study's author.

What makes the findings even more surprising is that these characteristic symptoms, thought to be the domain of more severe headaches, also occur in tension-type headaches. This finding is particularly significant given that tension-type headaches are the most common type of headache in the world, affecting thousands of people every day.

Analysis of “Migraine in Poland”

A team of researchers has analyzed data collected from more than 3,000 participants in the "Migraine in Poland" survey, a large-scale study designed to examine the characteristics and effects of different headaches in the Polish population. The study was initiated by Marta Waliszewska-Prosół, MD, of the Department of Neurology at the Wroclaw Medical University. Participants were recruited through social media, media advertisements, and collaboration with the medical and academic communities, allowing for one of the most comprehensive analyses of its kind.

In this large group, 166 individuals met the criteria for frequent episodic tension-type headache (eTTH), one of the most common types of headache. This variant of the condition is characterized by regular episodes that do not reach the intensity of chronic forms, making them relatively easy for patients and doctors to overlook or underestimate. Symptoms are often mild to moderate, and the pain itself is compressive without the pulsation or aggravation typical of migraines when exposed to physical activity.

The study also explored the demographic and clinical characteristics of the participants. The results indicate that most of those with eTTH are middle-aged women, consistent with general epidemiological trends for headaches. In addition, the analysis considered the co-occurrence of other symptoms, such as allodynia, a condition in which stimuli that are usually not painful, such as gentle touch or wearing glasses, trigger pain. Allodynia, although more common in migraines, was also present in some people with eTTH, which may indicate its potential influence on pain mechanisms in this condition. The study also took into account emotional factors, including depression, which can exacerbate the course and severity of complaints, highlighting the complex nature of this disease entity.

The researchers stressed that the choice of the data collection method—an online survey—may have influenced the results, but at the same time, it allowed the survey to reach a wide range of respondents, which increased the diversity of the sample. As a result, the survey provided unique data on the specifics of eTTH in the Polish population, taking into account a variety of socioeconomic factors, lifestyle, and access to medical care.