Orthostatic Intolerance and Other Autonomic Symptoms in Adolescents With Headaches

Background: The identification of autonomic comorbidity in adolescents with headaches could provide additional treatment strategies. The objective of this study was to identify and quantify autonomic symptoms in adolescents with headaches during a clinic visit using the COMPASS 31 questionnaire. Methods: The Institutional Review Board at Greenville Health System approved chart review of 92 adolescents seen in a pediatric neurology clinic with headache or syncope. All had active orthostatic testing and completed the COMPASS 31 and SCARED questionnaires. A 40 BPM (beats per minute) heart rate increase indicated postural orthostatic tachycardia. A score of >50% was considered high for the COMPASS 31 domains. A SCARED score >24 indicated anxiety. The relationship between high scores in COMPASS 31 domains and overall headache was studied by bivariate analysis and Fisher’s exact test; headache type by odds ratio; and headache frequency, anxiety, syncope, and orthostatic tachycardia by Chi-square analysis. Results: Eighty subjects had headaches, from which 65 were girls. Twelve subjects had syncope only, and 19 had both headache and syncope. Thirteen had orthostatic tachycardia; 43 had anxiety. Fifty-four subjects with headaches had high scores in the orthostatic intolerance (OI) domain, 37 in the pupillomotor domain, 17 in the vasomotor domain, and 8 in the gastrointestinal domain. OI was the only statistically significant domain when comparing subjects with and without headaches. Female sex, migraines, frequent headaches, and worsening headaches were statistically associated with OI domain high scores. Conclusions: The COMPASS 31 can be used in a busy clinic to identify and quantify OI in adolescents with headaches. Girls with migraine headaches, high headache frequency, and worsening headaches were more likely to have OI.