Abstract
Patients with neuropathic symptoms, including neuropathic pain and autonomic symptoms, frequently have headaches. They were evaluated by neurologists and underwent a diagnostic skin biopsy for small fiber neuropathy at Massachusetts General Hospital from 2018-2020. The correlations of neuropathic pain, autonomic symptoms, and headaches were examined. The results of skin biopsy, nerve conduction velocity/electromyography, and autonomic function testing were analyzed.
Most (73.8%) of the patients who underwent a skin biopsy were females. The mean age was 46.8. Most patients had neuropathic pain (61.3%). In addition, autonomic symptoms were present in 48.0% of patients. The prevalence of headaches was 48.2% in the whole study cohort, with 73.2% of headaches fulfilling the criteria of migraine.
We detected female dominance in patients who had headaches and migraine but not in the neuropathic pain and autonomic symptom groups. The correlations between headaches, migraine, neuropathic pain, and autonomic symptoms were examined. There were statistical correlations between headaches and neuropathic pain (p< 0.0001) and autonomic symptoms (p< 0.01). Similar trends were detected for migraine with neuropathic pain but not with autonomic symptoms.
The symptomatology was analyzed with the results of skin biopsy, nerve conduction velocity/electromyography, and autonomic function testing. Only autonomic symptoms have a significant positive correlation with positive autonomic function testing results. Otherwise, the results of skin biopsy, nerve conduction velocity/electromyography, and autonomic function testing had no significant correlation with neuropathic pain, headaches, and migraine. The lack of positive correlations between peripheral neuropathy studies and headaches suggests centralized mechanisms likely mediate headaches in patients with neuropathic pain and autonomic symptoms.