Pain-autonomic interactions

There are extensive interactions between the neural structures involved in pain sensation and autonomic control. The insular and anterior cingulate cortices, amygdala, hypothalamus, periaqueductal grey, parabrachial nucleus, nucleus of the solitary tract, ventrolateral medulla and raphe nuclei receive converging nociceptive and visceral inputs from the spinal and trigeminal dorsal horns and initiate arousal, affective, autonomic, motor and pain modulatory responses to painful stimuli. This review will focus on some central pain-autonomic interactions potentially relevant for the pathophysiology of primary headache.