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Rampazo ÉP, Rehder-Santos P, Catai AM, Liebano RE. Heart rate variability in adults with chronic musculoskeletal pain: A systematic review. Pain Pract 2024; 24:211-230. [PMID: 37661339 DOI: 10.1111/papr.13294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 08/14/2023] [Accepted: 08/21/2023] [Indexed: 09/05/2023]
Abstract
PURPOSE The aim of this review was to compare the heart rate variability (HRV) responses at rest of adults with chronic musculoskeletal pain against healthy controls. METHODS The PubMed, Scopus, Web of Science (Science and Social Science Citation Index), and CINAHL databases were searched, with no date restrictions. Two independent reviewers selected observational studies that characterized the HRV responses at rest in adults with chronic musculoskeletal pain compared with those of healthy controls. Methodological quality was assessed using the Downs and Black checklist. RESULTS This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. HRV in adults with chronic musculoskeletal pain was evaluated systematically. Of the 4893 studies screened, 20 of poor-to-moderate quality met the inclusion criteria. Most studies used electrocardiography and at least one time and/or frequency domain index. Studies were found that investigated HRV in adults with temporomandibular disorders, neck pain, whiplash, low back pain, and fibromyalgia. The heterogeneity of the studies in relation to painful conditions, parameters or position for HRV analysis precluded a meta-analysis. In general, these studies seem to show increased sympathetic and decreased parasympathetic modulation in adults with musculoskeletal pain when compared to controls. CONCLUSIONS Adults with musculoskeletal pain exhibited a decline in HRV compared to controls. However, definitive conclusions cannot be drawn since the evidence is heterogeneous and of moderate quality. Further high-quality research with standardized measurements is needed.
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Affiliation(s)
- Érika P Rampazo
- Physiotherapeutic Resources Research Laboratory, Department of Physical Therapy, Federal University of São Carlos (UFSCar), Rod Washington Luiz, km 235, São Carlos, 13565-905, São Paulo, Brazil
| | - Patrícia Rehder-Santos
- Cardiovascular Physiotherapy Laboratory, Department of Physical Therapy, Federal University of São Carlos (UFSCar), Rod Washington Luiz, km 235, São Carlos, 13565-905, São Paulo, Brazil
| | - Aparecida M Catai
- Cardiovascular Physiotherapy Laboratory, Department of Physical Therapy, Federal University of São Carlos (UFSCar), Rod Washington Luiz, km 235, São Carlos, 13565-905, São Paulo, Brazil
| | - Richard E Liebano
- Physiotherapeutic Resources Research Laboratory, Department of Physical Therapy, Federal University of São Carlos (UFSCar), Rod Washington Luiz, km 235, São Carlos, 13565-905, São Paulo, Brazil
- Department of Rehabilitation Sciences, University of Hartford, West Hartford, Connecticut, USA
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Sleep and Chronobiology as a Key to Understand Cluster Headache. Neurol Int 2023; 15:497-507. [PMID: 36976672 PMCID: PMC10051701 DOI: 10.3390/neurolint15010029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 03/10/2023] [Accepted: 03/13/2023] [Indexed: 03/17/2023] Open
Abstract
The cluster headache is a primary headache characterized by attacks of unilateral pain associated with ipsilateral cranial autonomic features. These attacks recur in clusters during the years alternating with periods of complete remission, and their onset is often during the night. This annual and nocturnal periodicity hides a strong and mysterious link among CH, sleep, chronobiology and circadian rhythm. Behind this relationship, there may be the influence of genetic components or of anatomical structures such as the hypothalamus, which are both involved in regulating the biological clock and contributing even to the periodicity of cluster headaches. The bidirectional relationship manifests itself also with the presence of sleep disturbances in patients affected by cluster headaches. What if the key to studying the physiopathology of such disease could rely on the mechanisms of chronobiology? The purpose of this review is to analyze this link in order to interpret the pathophysiology of cluster headaches and the possible therapeutic implications.
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de Coo IF, van Oosterhout WPJ, Wilbrink LA, van Zwet EW, Ferrari MD, Fronczek R. Chronobiology and Sleep in Cluster Headache. Headache 2019; 59:1032-1041. [PMID: 31148161 PMCID: PMC6771706 DOI: 10.1111/head.13567] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/07/2019] [Indexed: 01/03/2023]
Abstract
Background Cluster headache attacks follow a striking circadian rhythm with an intriguing influence of sleep. We aim to investigate differences in sleep quality, chronotype, and the ability to alter individual sleep rhythms in episodic and chronic cluster headache patients vs controls. Methods Cluster headache patients and non‐headache controls from the Dutch Leiden University Cluster headache neuro‐Analysis program aged 18 and above completed web‐based questionnaires in a cross‐sectional study. Results A total of 478 episodic, 147 chronic cluster headache patients and 367 controls participated. Chronic cluster headache patients had more often early chronotypes than controls, as measured by mid‐sleep phase (P = .021 adjusted B −15.85 minutes CI −29.30; −2.40). Compared to controls, chronic cluster headache participants were less able to alter their sleep rhythms (P < .001 adjusted B −1.65 CI −2.55; 0.74), while episodic cluster headache participants reported more difficulty in coping with reduced sleep (P = .025 adjusted B 0.75 CI 0.09; 1.40). Sleep quality was reduced in both types of cluster headache compared to controls (“poor sleepers”: 71.4% (105/147) in chronic and 48.3% (235/367) in episodic cluster headache vs 25.6% (94/367) in controls; both P < .001; episodic adjusted B −1.71 CI 0.10; 0.32; chronic adjusted B −0.93 CI 0.24; 0.65). Conclusion Sleep quality is decreased in both episodic and chronic cluster headache, most likely caused by cluster headache attacks that strike during the night. Episodic cluster headache patients report more difficulty in coping with reduced sleep, while chronic patients are less able to alter their sleep rhythm. Although not directly proven, cluster headache patients will likely benefit from a structured, regular daily schedule.
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Affiliation(s)
- Ilse F de Coo
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands.,Basalt Medical Rehabilitation Center, Hague, the Netherlands
| | - Willebrordus P J van Oosterhout
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands.,Department of Neurology, OLVG Hospital, Amsterdam, the Netherlands
| | | | - Erik W van Zwet
- Department of Medical Statistics and Bioinformatics, Leiden University Medical Center, Leiden, the Netherlands
| | - Michel D Ferrari
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands
| | - Rolf Fronczek
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands.,Slaap-Waakcentrum SEIN, Heemstede, the Netherlands
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Barloese M, Petersen AS, Guo S, Ashina M, Mehlsen J, Jensen RH. Sphenopalatine ganglion stimulation induces changes in cardiac autonomic regulation in cluster headache. Clin Physiol Funct Imaging 2017; 38:808-815. [PMID: 29105279 DOI: 10.1111/cpf.12484] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Accepted: 10/11/2017] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Cluster headache is characterized by attacks of severe unilateral pain accompanied by cranial and systemic autonomic changes. Our knowledge of the latter is imperfect. This study aimed to investigate the effect of low-frequency sphenopalatine ganglion stimulation on cardiac autonomic regulation. MATERIALS AND METHODS In a double-blind, randomized, sham-controlled crossover design, patients received low-frequency and sham stimulation. RR intervals were recorded, and heart rate variability was analysed (time-domain, frequency-domain, nonlinear parameters). Headache characteristics, including cranial autonomic symptoms, were recorded at baseline and every 10 min for 60 min. RESULTS Sixteen patients were included. Changes in heart rate variability from baseline in the analysed parameters differed significantly between low-frequency and sham stimulation. Initially, during low-frequency stimulation, there was a greater increase in heart rate compared to sham (P<0·05) and changes in the frequency, nonlinear and time domain (P<0·05) reflecting a higher sympathetic tone. These preceded the observed cranial autonomic symptoms. Ten episodes of cluster-like attacks were reported (six following low-frequency stimulation, four following sham). During these, parasympathetic tone (P<0·05) was higher compared to baseline. CONCLUSIONS In cluster headache patients subjected to low-frequency and sham stimulation of the sphenopalatine ganglion, we found changes indicating higher sympathetic tone during low-frequency stimulation preceding cranial autonomic symptoms or cluster pain. During cluster pain, regardless of stimulation parameters, we saw increased parasympathetic activity, congruent with previous reports. The results indicate involvement of cardiac autonomic regulation before and during cluster headache attacks.
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Affiliation(s)
- Mads Barloese
- Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet-Glostrup, Glostrup, Denmark.,Danish Headache Center, Rigshospitalet-Glostrup, Glostrup, Denmark
| | - Anja S Petersen
- Danish Headache Center, Rigshospitalet-Glostrup, Glostrup, Denmark
| | - Song Guo
- Danish Headache Center, Rigshospitalet-Glostrup, Glostrup, Denmark
| | - Messoud Ashina
- Danish Headache Center, Rigshospitalet-Glostrup, Glostrup, Denmark
| | - Jesper Mehlsen
- Department of Cardiology, Syncope Center, Bispebjerg and Frederiksberg Hospitals, Frederiksberg, Denmark
| | - Rigmor H Jensen
- Danish Headache Center, Rigshospitalet-Glostrup, Glostrup, Denmark
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Barloese MCJ. The pathophysiology of the trigeminal autonomic cephalalgias, with clinical implications. Clin Auton Res 2017; 28:315-324. [DOI: 10.1007/s10286-017-0468-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2017] [Accepted: 09/11/2017] [Indexed: 01/03/2023]
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Barloese MCJ. A Review of Cardiovascular Autonomic Control in Cluster Headache. Headache 2015; 56:225-39. [PMID: 26616143 DOI: 10.1111/head.12730] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Revised: 09/02/2015] [Accepted: 09/21/2015] [Indexed: 01/03/2023]
Abstract
OBJECTIVE This review aims to evaluate existing literature concerning cardiovascular autonomic function and CH. Suggestions about future research are offered and known difficulties in investigating the autonomic nervous system in cluster headache are discussed. BACKGROUND Little is known of the pathophysiological mechanisms behind cluster headache. Cranial autonomic features are an inherent and diagnostic feature; however, a number of studies and clinical observations support the involvement of systemic autonomic control in its pathophysiology. Further, cluster headache attacks are apparently more easily triggered during periods of parasympathetic dominance. A better understanding of this interaction may provide insight into central autonomic regulation and its role in cluster headache. METHODS A PubMed search was performed in April 2015 using the search terms "cluster headache," "cardiovascular," "autonomic nervous system," and "cardiac." References of identified articles were also searched for relevant articles. Studies were included if they contained data on cardiovascular or autonomic responses to autonomic tests, induced or spontaneous attacks. RESULTS In total, 22 studies investigating cardiac autonomic control in cluster headache were identified. Three overall categories of investigations exist: (1) Those studying changes in heart rate, blood pressure, and electrocardiographic changes; (2) those employing various clinical autonomic tests; and finally (3) those using spectral and nonlinear analysis of heart rate variability. Although not completely congruent, overall, results suggest ictal hyperactivation of the parasympathetic branch and a sympathetic deficit. Subclinical autonomic dysregulation is also present in the pain-free state. CONCLUSION Cardiac autonomic control is subclinically affected in cluster headache. The changes could be attributed to the suggested central dysregulation present in this disorder.
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Affiliation(s)
- Mads C J Barloese
- Department of Clinical Physiology and Nuclear Medicine, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Denmark.,Danish Headache Center, Glostrup Hospital, Denmark
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Barloese MCJ. Neurobiology and sleep disorders in cluster headache. J Headache Pain 2015; 16:562. [PMID: 26289164 PMCID: PMC4542772 DOI: 10.1186/s10194-015-0562-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Accepted: 08/10/2015] [Indexed: 11/10/2022] Open
Abstract
Cluster headache is characterized by unilateral attacks of severe pain accompanied by cranial autonomic features. Apart from these there are also sleep-related complaints and strong chronobiological features. The interaction between sleep and headache is complex at any level and evidence suggests that it may be of critical importance in our understanding of primary headache disorders. In cluster headache several interactions between sleep and the severe pain attacks have already been proposed. Supported by endocrinological and radiological findings as well as the chronobiological features, predominant theories revolve around central pathology of the hypothalamus. We aimed to investigate the clinical presentation of chronobiological features, the presence of concurrent sleep disorders and the relationship with particular sleep phases or phenomena, the possible role of hypocretin as well as the possible involvement of cardiac autonomic control. We conducted a questionnaire survey on 275 cluster headache patients and 145 controls as well an in-patient sleep study including 40 CH-patients and 25 healthy controls. The findings include: A distinct circannual connection between cluster occurrence and the amount of daylight, substantially poorer sleep quality in patients compared to controls which was present not only inside the clusters but also outside, affected REM-sleep in patients without a particular temporal connection to nocturnal attacks, equal prevalence of sleep apnea in both patient and control groups, reduced levels of hypocretin-1 in the cerebrospinal fluid of patients and finally a blunted response to the change from supine to tilted position in the head-up tilt table test indicating a weakened sympathoexcitatory or stronger parasympathetic drive. Overall, these findings support a theory of involvement of dysregulation in hypothalamic and brainstem nuclei in cluster headache pathology. Further, it is made plausible that the headache attacks are but one aspect of a more complex syndrome of central dysregulation manifesting as sleep-related complaints, sub-clinical autonomic dysregulation and of course the severe attacks of unilateral headache. Future endeavors should focus on pathological changes which persist in the attack-free periods but also heed the possibility of long-lived, cluster-induced pathology.
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Barloese MCJ, Mehlsen J, Brinth L, Lundberg HIS, Jennum PJ, Jensen RH. Reduced Baroreflex Sensitivity in Cluster Headache Patients. Headache 2015; 55:815-24. [DOI: 10.1111/head.12586] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Mads C. J. Barloese
- Department of Clinical Physiology and Nuclear Medicine; Frederiksberg and Bispebjerg Hospital; University of Copenhagen; Frederiksberg Denmark
- Danish Headache Center; Department of Neurology; Glostrup Hospital; University of Copenhagen; Glostrup Denmark
| | - Jesper Mehlsen
- Department of Clinical Physiology and Nuclear Medicine; Frederiksberg and Bispebjerg Hospital; University of Copenhagen; Frederiksberg Denmark
| | - Louise Brinth
- Department of Clinical Physiology and Nuclear Medicine; Frederiksberg and Bispebjerg Hospital; University of Copenhagen; Frederiksberg Denmark
| | - Helena I. S. Lundberg
- Department of Clinical Physiology; Glostrup Hospital; University of Copenhagen; Glostrup Denmark
| | - Poul J. Jennum
- Danish Center for Sleep Medicine; Department of Neurophysiology; Glostrup Hospital; University of Copenhagen; Glostrup Denmark
| | - Rigmor H. Jensen
- Danish Headache Center; Department of Neurology; Glostrup Hospital; University of Copenhagen; Glostrup Denmark
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