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The Autonomic Nervous System and its Relationship to
Headache
by Dr. Dietrich Klinghardt, M.D., PhD
Thomas Willis, the "father" of modern neurology, proposed the
vascular theory of headache in 1!.#e suggested that the source of
pain $as not the brain itself but nerve fibers being pulled by
the
distended vessels%1&
#arold Wollf reported in 1'() on the autonomic nervous system
%*+& involvement in migraine
headaches- he postulated that the primary cause of migraine is
vasoconstriction of the etracranial
arteries in the early phases of the headache follo$ed by
vasoconstriction /$ith associated peripheralvasoconstriction in the
limbs%&. 0ther signs suggesting *+ involvement in headache
include nausea,
diarrhea%(&,constipation %&, coldness in hands and feet,
paroysmal tachycardia %2&, chest pain %&,
variant angina %!&, paraesthesia and numbness of the s3in
and others. The vascular theory of migraine$as the generally
accepted $or3ing model until the cell receptor theory came along
around 1'!). 4n
1')5 +obel pri6e laureate Paul 7hrlich postulated the eistence
of cell receptors, $hose interaction
$ith specific agents $as a mechanism responsible for many
illnesses. 8eceptor biochemistry has
become the basis for most pharmacological approaches. * recent
eample is the development of thedrug sumatriptan $hich attaches to
the 2/#T1 receptor. 0ther receptors involved in headache
include
the alpha/ receptors, u/opioid receptors and somatostatin
receptors. 9ntil today there are numerous
theories on the neurophysiology of headache, none of $hich are
completely proven%5&.
Anatomy
To understand the role of the *+ in headache, the anatomy has to
be understood. The *+ servesthree basic functions in the brain-
1. 4nnervation of the smooth muscleof the vascular tree $ithin
the brain. * stress signal $ithin the
sympathetic nervous system $ill generally lead to
vasoconstriction in the affected area of the brain.
. Transport of neuropeptidesand informational substances $ithin
the aons of the *+ into the
terminals $ithin the vascular endothelium. everal do6en
substances travel via the *+ aons to theendothelium and are
released into the bloodstream, causing both local and systemic
effects. erotonin,
en3ephalin, nitric oide and the inflammatory peptides such as
substance P, neuro3inin * and
calcitonin gene related peptide are thought to be involved in
the genesis of migraine pain.
(. 5): of *+ fibers are thought to be sensory in nature and may
be directly involved in painperception. ensory autonomic nerves are
present in the cranial membranes %dura, arachnoid,
tentorium&, in the connective tissue and in the $alls of the
larger blood and lymphatic vessels. The*+ is 3no$n to have a
$ind/up effect %sensiti6ing effect& on the $ide dynamic
range%WD8& cells in
the spinal chord, $hich modulate the pain path$ay. 4f pain
originates for eample in the trigeminal
system, this message has to pass through the WD8 cells. 4f the
threshold is lo$ered by arousal of thesympathetic nervous system in
the same segment, the pain message passes through the WD8 cell
up
into the brain. *rousal in the *+ can be caused by any ecitatory
stimulus acting on the aons, nerve
endings or ganglia of the *+. ;ommon in the dental arena are
abnormal electrical signals %"abnormalsignaling"& arising from
dysfunctional scars %from tooth etractions or surgical
procedures& or from
dysfunctional teeth %decay, incompatible restoration materials,
mechanical stress, toicity from filling
materials and infections etc.&. The dental pulp has its o$n
autonomic nervous system mostlycomprised of sympathetic fibers
traveling piggybac3 on the arteries, veins and lymphatic vessels of
the
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"iagnosis
The follo$ing diagnostic approaches have emerged in the last ()
years, that are able to assess
dysfunction of the *+ and>or locate a focal area-
1. #eart rate variability testing. Thermography(. 7lectrodermal
screening %7*&
. *utonomic response testing %"3inesiology", "muscle
testing"&
2. Palpation>clinical eam. ;hinese pulse diagnosis %also
*&
Treatment
The treatment consists in an appropriate intervention that
eliminates or treats the disturbing factor.
#ere is a list of common solutions that have emerged in the
7uropean +eural Therapy contet -
1. !luster headache#the focus is usually a small area inside the
nose, $here the middle turbinatetouches the nasal septum. Treatment
is either in
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%iterature
1. ac3s,0.- Migraine / 9nderstanding a ;ommon Disorder. ?er3eley
9niversity of ;al.Press, 1'52-1/
5, 5
. Dalessio, D.=.- WolffEs #eadache and other #ead Pain. th
ed.+e$ For3. 0ford 9niv.Press, 1'5)(. elbyu,@. 0bservations on 2))
cases of Migraine and *llied ascular #eadache.
=.+eurol.+eurosurg.Psychiatry 1'), (-(/(. ;ady,8.-Treating the
#eadache Patient. Marcel De33er, 4+;, +e$ For3 1''2, pg.2. Thomas,
W*- Paroysmal Tachycardia in Migraine. =*M* 1'2. 5-2'/2!)
. ?riggs,=C- Precordial Migraine. is;hest 1'2. 1- (2/)
!. Miller,D.- 4s ariant *ngina the coronary Manifestation of a
@enerali6ed asospastic DisorderG+e$ 7ngl = Med 1'51. ()- !(/!
5. 8.;ady- Treating the #eadache Patient. Marcel De33er, +.F.,
1''2
