Evaluation of auditory startle response in migraine and tension type headache

Abstract

Objective: This study aimed to investigate the auditory startle response (ASR) in the ictal period of primary headache disorders. ASR may serve as a potential marker of brainstem hypersensitivity to external stimuli.

Methods: The study included patients diagnosed with episodic migraine (EM, n=13), chronic migraine (CM, n=9), chronic tension-type headache (CTTH, n=9), and medication-overuse headache (MOH, n=8) as well as a control group of healthy individuals (n = 23). Headache diagnoses were established in accordance with the International Classification of Headache Disorders, 3rd edition (ICHD-III). ASR measurements were performed in all participants, and in patients, assessments were conducted in ictal period. ASR parameters were compared across all groups.

Results: Total ASR probability was significantly elevated in patients with headache compared to healthy controls. In recordings from the orbicularis oculi muscle, both response duration and area under the curve (AUC) were significantly increased in patients with EM and CM. In contrast, only response duration was prolonged in individuals with CTTH and MOH. The presence of associated symptoms such as photophobia, phonophobia, osmophobia, or allodynia showed no correlation with ASR enhancement.

Conclusion: The results demonstrate ASR hyperactivity during the ictal phase in patients with EM, CM, CTTH and MOH, with the most pronounced changes observed in EM and CM. These findings suggest that ASR alterations are associated with the pain component of headache disorders rather than with accompanying sensory symptoms.