Learn more about autonomic symptoms of migraine and how to talk to your doctor about them.

When people think of migraine, they often think of symptoms like head pain, nausea or light and sound sensitivity. But there is another group of symptoms that includes flushing, tearing and runny or stuffy nose. These are called autonomic symptoms and may occur in migraine or with a group of headache disorders called the trigeminal autonomic cephalalgias (TACs).

Autonomic refers to actions that are involuntary or actions you don’t consciously control—like the beating of your heart, digestion or blood pressure. They are controlled by a part of your nervous system called the autonomic nervous system.  Autonomic symptoms are signs that something is changing with these systems. More specifically, cranial autonomic symptoms affect the cranium or the head.

If you experience these symptoms during a headache, it may be an indication that you have migraine or one of the TACs. Understanding what autonomic symptoms are and their connection to migraine and other headache disorders is helpful. This information can help you talk to your doctor and better diagnose, prevent and treat migraine.

What are autonomic symptoms?

Autonomic symptoms are often misdiagnosed as sinus headache when they are actually symptoms of migraine. Autonomic symptoms can include:

  • Flushing
  • Tearing
  • Facial swelling
  • Drooping of the eyelids
  • Runny or stuffy nose
  • Pupil changes
  • Eye redness
  • Forehead or facial sweating

A recent study found that about 70% of people with chronic migraine and 56% of people with episodic migraine reported one or more cranial autonomic symptoms—eye redness, tearing and blurred vision. Another symptom also includes unilateral headache. It also found that people with migraine who experience autonomic symptoms are more likely to experience unilateral (one-sided) headaches and more severe and frequent attacks. When they occur with migraine, autonomic symptoms tend to be less severe and bilateral (both sides) than with the TACs.

People with paroxysmal hemicrania, hemicrania continua, SUNCT syndrome and cluster headache (the TACs) can also experience autonomic symptoms, so it’s important to share all symptoms with your doctor to land on an accurate diagnosis and pursue the right treatment. These headache disorders differ from migraine in that they are more severe, have attacks that recur multiple times a day and are shorter-lasting.

As researchers learn more about autonomic symptoms, they may be able to better understand how changes in autonomic body systems are connected to migraine, what triggers migraine symptoms and how to treat them effectively.

How to Talk to Your Doctor

If you experience autonomic symptoms, it is important that you share them with your doctor. By openly communicating about your condition, it can help your doctor get a better understanding of your specific migraine or headache disorder and make an accurate diagnosis.

A headache journal can also help you keep track of your symptoms, including how often they happen, how severe they are and how long they last. Advocate for yourself by asking if the headache pain and accompanying autonomic symptoms may be related to migraine or a TAC. Work with your doctor to create a plan for managing and treating these symptoms.

In addition to your autonomic symptoms, it’s helpful to share both your general and other specific migraine symptoms. Be open and use descriptive words and imagery to make it clear what happens before, during and after a migraine attack and how it feels. If you are unsure how to get started with talking to your doctor, there are many ways and resources you can use.

How are autonomic symptoms treated?

Your doctor can help you create a plan for migraine treatment. There are acute treatments, which are used when an attack is starting, and preventive treatments, which are used regularly to help prevent or reduce the frequency, severity, or length of time of attacks. Certain lifestyle changes can also help manage migraine.

Research shows that autonomic symptoms may be a warning sign that episodic migraine is progressing to chronic migraine. At that point, you and your doctor might want to have a conversation about preventive treatment.

When autonomic symptoms are connected to migraine, they can be treated with the same medications used for migraine. For example, it’s been found that triptans can not only treat migraine pain, but they may also improve unilateral autonomic symptoms. Some people with migraine have seen improvement by using OnabotulinumtoxinA (Botox) as a preventive measure in cases where previous treatments have failed.

Emerging data also suggests that the presence of cranial autonomic symptoms may help predict which treatments would be most effective for that individual.

The American Migraine Foundation has resources to help you learn more about migraine and how to speak to your doctor about migraine. With open communication, you and your doctor can build the best treatment plan for your specific migraine symptoms.

The American Migraine Foundation is committed to improving the lives of those living with this debilitating disease. For more of the latest news and information on migraine, visit the AMF Resource Library. For help finding a healthcare provider, check out our Find a Doctor tool. Together, we are as relentless as migraine.