The relationship between autonomic symptoms and quality of life in patients with migraine: A multicenter cross-sectional observational study

Background & Objectives: Migraine is a complex disorder that negatively affects the quality of life. Interictal or ictal cranial autonomic symptoms (CASs) are observed in migraine; however, data regarding extracranial autonomic symptoms (ECASs) are limited. This study aimed to evaluate autonomic symptoms in patients with migraine and to investigate the relationship between these symptoms and the quality of life. Method: The study was designed as a cross-sectional observational study. Ictal CASs in migraine were assessed. Participants completed the Composite Autonomic Symptom Scale (COMPASS-31), Migraine Disability Assessment Score (MIDAS), Headache Impact Test (HIT-6) and Migraine-Specific Quality-of-Life Questionnaire (MSQoL). The relationships between autonomic symptoms, headache characteristics and scale scores were analyzed. Patients were categorized as having episodic or chronic migraine, and migraine with or without aura. Data were compared across all patient groups and healthy controls. Results: The most common ictal CASs in patients with migraine were lacrimation (38.3%, n = 69) and conjunctival injection (28.3%, n = 51). COMPASS-31 scores were significantly higher in patients with migraine compared with healthy controls (p = 0.001). Higher COMPASS-31 scores were also observed in patients with migraine with aura and in those with greater disability (MIDAS grades 3-4) (p = 0.009, p = 0.001). Additionally, a moderate negative correlation was detected between total COMPASS-31 scores and the MSQoL scores (p = 0.001, r =-0.410). Conclusions: Autonomic symptoms are common in patients with migraine, especially in migraine patients with aura. These symptoms are associated with lower quality of life and higher disability levels.