BACKGROUND:Cranialautonomicsymptoms（CAS）aredistinguishingfeaturesoftrigeminalautonomiccephalalgias（TAC）,ofwhichclusterheadache（CH）isthemostcommon,buttheycanoccurinmigrainepatients.Formigrainewithstrictlyunilateralheadache,thepresenceofCASmightcausediagnosticconfusionwithCH.CharacteristicsofCASinmigraineandcomparisonswiththoseinCHhaverarelybeenreported.METHODS:ThisstudyprospectivelyrecruitedconsecutivemigraineandCHpatientstreatedataheadacheclinic.WesurveyedsixCASitemsincluding:conjunctivalinjection,lacrimation,nasalcongestion,rhinorrhea,eyelidedemaandforehead/facialsweating.TheCAScharacteristicsrecordedincludedlaterality,intensity,timesequenceandconsistencywithheadacheattacks.RESULTS:Werecruited786migrainepatients（625F/161M,meanage40+/-13years）and98（11F/87M,meanage36+/-11years）CHpatients.Theprevalenceof>/=1CASinmigrainepatientswas56%anddidnotdifferamongmigrainesubtypes.Exceptforforehead/facialsweating,thefeaturesoftheotherCASdifferedbetweenpatientswithmigraineandCH:CASinmigrainetendedtobebilateral（oddsratio（OR）:5.8-23.8amongdifferentCAS）,beunrestrictedtotheheadachesides（OR:5.0-20.4）,appearwithmild-to-moderateintensity（OR:1.7-7.7）andbeinconsistentwithheadacheattacks（OR:2.8-6.7）.CONCLUSIONS:CASwerepresentinhalfofourmigrainepatientsandtheclinicalfeaturesmayhelpdifferentiatemigrainefromCH.背景：脑自主神经症状是三叉神经性头痛的主要特点，丛集性头痛是其中最常见的，但它们也可能发生在偏头痛患者。偏头痛，即严格意义上的单侧头痛，脑自主神经症状的出现会造成与丛集性头痛诊断的混乱。目前很少有人报告丛集性偏头痛与偏头痛的脑自主神经症状的区别。方法：本研究前瞻性连续观察头痛门诊的偏头痛患者和丛集性头痛患者。我们调查的6个脑自主神经症状项目包括：结膜充血，流泪，鼻塞，流鼻涕，眼睑水肿和前额/面部出汗。脑自主神经症状特点包括头痛的偏侧，强度，时间性和持续性。结果：我们观察的786偏头痛患者（625F/161M，平均年龄40±13岁）和98（11F/87M，平均年龄36±11岁）的丛集性头痛患者患者。在偏头痛患者中有脑自主神经症状为56％，在偏头痛的不同亚型没有差异。除了额头/面部出汗，偏头痛患者和丛集性头痛患者的其他脑自主神经症状的特点是不同的。偏头痛的脑自主症状往往是双侧的（OR：5.8-23.8），不限于头痛侧的（OR：5.0-20.4），出现轻到中等程度紧张的（OR：1.7-7.7）和头痛发作一致的（OR：2.8-6.7）。结论：目前有一半的偏头痛患者的有脑自主神经症状，这一临床特征可能有助于区分偏头痛和丛集性偏头痛。专家评价：DavidDodickwithToddJSchwedtMayoClinicScottsdale,UnitedStatesofAmericaNeurologicalDisordersThislargestudyconfirmsthat,althoughcranialautonomicfeaturesdistinguishthetrigeminalautonomiccephalalgias（TACs）andhemicraniacontinuafromotherheadachetypes,theyarealsocommonlypresentduringmigraine.However,autonomicsymptomsduringmigrainetendtobelesssevere,bilateral,andinconsistentlypresentfromoneattacktoanother.PresenceofcranialautonomicsymptomsisessentialforthediagnosisoftheTACsandhemicraniacontinua.TheTACsincludeclusterheadache,paroxysmalhemicrania,andshort-lastingunilateralneuralgiformheadacheattackswithconjunctivalinjectionandtearing（SUNCT）.Commonautonomicsymptomsincludeconjunctivalinjection,eyelidedema,miosis,ptosis,lacrimation,nasalcongestionorrhinorrhea,andfacialsweating.AutonomicsymptomsmustoccuripsilateraltotheheadachefortheformaldiagnosisoftheTACsandhemicraniacontinua.AlthoughcranialautonomicsymptomsarehallmarkfeaturesoftheTACsandhemicraniacontinua,ithasbeenrecognizedthattheymayalsooccurduringmigraineheadaches.Thisinvestigationanalyzedthefrequencyandcharacteristicsofautonomicsymptomsduringmigraineandclusterheadaches.Theinvestigatorsprospectivelyenrolled786migraineursand98clusterheadachesubjects.Fifty-sixpercentofmigraineursand97%ofclusterheadachesubjectsreportedatleastoneautonomicsymptomassociatedwiththeirheadaches.Amongmigraineurswithautonomicsymptoms,forehead/facialsweatingwasthemostcommon（51.7%）followedbylacrimation（44.2%）,nasalcongestion（25.2%）,conjunctivalinjection（23.8%）,rhinorrhea（21.5%）,andeyelidedema（15.6%）.Themeannumberofautonomicsymptomswaslowerinmigrainecomparedtocluster（1.8±1.1vs.3.5±1.4,p<0.001）.Migrainesubjectshadahigherfrequencyofbilateralautonomicsymptoms（rangingfrom67%-95%dependingonthesymptom,oddsratio（OR）migrainetoclusterrangingfrom5.8to23.8）.Autonomicsymptomswerelesssevereduringmigrainethancluster（OR1.7to7.7）andlessfrequentlyoccurredduringallmigraineattacks（OR2.8to6.7）.Thecombinationofautonomicfeaturesthatwasmostpredictiveformigrainewassymptomsoccurringbilaterallywitheithermild-to-moderateintensityofautonomicsymptomsoroccurrenceofsymptomsintheabsenceofheadache.Strengthsofthisstudyincludethelargesamplesizeanddetailedquestionnaireregardingautonomicsymptoms.Limitationsincluderecallbias（subjectswereaskedtorecallwhetherornottheyhaveautonomicsymptomsduringheadachesasopposedtoprospectivelydocumentingtheirpresence）,inabilitytodetectptosisandmiosisduetopoorreliabilityofself-report,andlackofconfirmationanddetectionofautonomicsymptomsbywitnesses.However,theselimitationswouldlikelyresultinanunderestimationofsymptoms.Thisstudyconfirmsthepriorsuggestionthatcranialautonomicsymptomsarecommonduringmigraineheadaches.Comparedtoclusterheadache,autonomicsymptomsinmigrainetendtobelesssevere,bilateral,andoccurlessconsistentlywitheachheadache.