The Cortez Autonomic Physiology Lab at the University of Utah is currently conducting SIX research studies that investigate autonomic dysfunction in traumatic brain injury, migraine, dysautonomia, and multiple sclerosis. Below are brief descriptions of these studies.
Principal Investigator: Melissa Cortez
Traumatic Brain Injury (TBI)
A strong jolt or blow to the head can result in TBI. In general, TBI can range from mild (e.g., concussion) to severe. TBIs disrupt the brain’s normal function and can cause a range of symptoms—including headache, dizziness, brain fog, irritability, and altered sleep—and can last months or years after injury. Persistent post-concussive symptoms may be related to autonomic dysregulation, specifically cardiovascular function. Given its prevalence in the general population, understanding the autonomic mechanisms underlying post-concussive symptoms and the factors that cause them to persist is critical to reducing the health burden of mTBI.
Investigating Autonomic Function and Sensory Thresholds as Biomarkers in Traumatic Brain Injury
Up to 60% of patients with mTBI experience persistent post-concussive symptoms like headache, which can remain treatment refractory for many. Recent studies have suggested that impaired autonomic regulatory control contributes to persistent symptoms in mTBI and post-concussive syndrome. The aim of this study is to assess objective physiological makers of autonomic and multimodal sensory function in TBI patients and determine whether these correspond to disease severity and predict progression. These results could provide insight into the mechanistic basis of autonomic and sensory dysfunction in mTBI and open new pathways for diagnosis and treatment.
Headache and Migraine
Headache is a broad term describing a widespread but poorly understood physiological symptom. Headache broadly refers to pain or discomfort in any region of the head. Headaches are commonly grouped into one of two categories: primary headaches, which have no known underlying cause, or secondary headaches, which result from another condition. Migraines are a primary headache disorder and are among the most debilitating disorders globally. Migraines typically include moderate to severe pain, nausea or vomiting, and heightened sensitivity to sensory input like light or sound. Fortunately, headaches and migraines are often transient, lasting only hours to days. Nevertheless, headaches and headache disorders are immensely burdensome to individuals, healthcare systems, and society at large – and for some, can evolve to a daily, rather than episodic, burden (aka chronic headache). Understanding the underlying physiology of headaches and their related symptomologies would significantly improve their medical management and treatment.
Investigating Autonomic Function and Sensory Threshold as Biomarkers in Headache and Facial Pain Disorders
Headache disorders are a class of pathological conditions with primary headache and facial pain. The causes and symptoms of headache disorders vary considerably, but little is known about their distinguishing physiological characteristics. The aim of this study is to investigate different autonomic, sensory, and affective characteristics of common headache disorders using a battery of clinical, physiological, and psychometric measures.
Sensory Amplifications as Biomarkers of Migraine Progression: R61 Discovery Phase
Migraine is a common and disabling neurological disease. Migraines can be episodic or chronic and progress along one of three trajectories: remission, persistence, and progression. The progression of migraines to a chronic condition is three times more burdensome than episodic migraines and presents a number of clinical risk factors, including opioid misuse. Identifying patients who are most likely to progress to chronic migraines is a crucial step toward developing preventative interventions for migraine. Examining sensory amplification—as an objective biomarker of migraine—may provide insights into who may be most at risk of developing chronic migraine. As such, the goal of this study is to determine whether sensory biomarkers accurately predict migraine progression.
Learn more about the study here.
Postural Tachycardia Syndrome (PoTS)
PoTS is a chronic syndrome of the autonomic nervous system. It is primarily characterized by orthostatic intolerance—aversive physiological symptoms that occur upon standing but resolve with sitting or lying down. Common symptoms of PoTS, leading to orthostatic intolerance, include a rapid increased heart rate, dizziness, and lightheadedness upon standing, as well as fatigue and “brain fog.” PoTS primarily affects previously healthy individuals after an illness, infection, concussion, non-concussion-related trauma, or surgery. There is currently no cure for PoTS, but there are a number of effective pharmacological and non-pharmacological treatments. Exercise is the most effective means to reduce PoTS symptoms, but due to the nature of these symptoms, exercise intolerance is common.
Assessing Clinical Phenotypes and Symptom Burden in PoTS
An estimated 3 million individuals in the USA are affected by PoTS. Yet, the pathophysiology and heterogeneous symptom presentation in PoTS and related disorders are not well understood. The aim of this study is to better understand and characterize the clinical phenotypes of PoTS patients (i.e., different symptom presentations and comorbid disorders), their impact on quality of life, and how they change over time.
Evaluating the Effect of Health Coaching on Physical Activity in PoTS
Researchers and clinicians support exercise as a first line treatment for PoTS. However, adherence to therapeutic exercise regimens is not guaranteed, particularly due to potential symptom exacerbation, including worsening orthostatic and exercise intolerance. Motivational interviewing (MI) is an evidenced-based coaching technique that specifically addresses change-resistant behaviors. This proof-of-concept feasibility study aims to determine the effectiveness of MI-based coaching compared to standard techniques in fostering adherence to therapeutic exercise.
Utah ADaPT Program
The Autonomic Disorder adaptive Physical Therapy (ADaPT) protocol was developed by a team of Utah-based physical therapists and neurologists who specialize in the treatment and management of autonomic disorders, including PoTS, autonomic neuropathy/failure, and other disorders leading to activity and orthostatic intolerance. Existing graded exercise protocols have been found to have limited adherence due to their rigid requirements for progression and lack of adaptability. The Utah ADaPT protocol allows for the necessary individualization to meet participants' needs, while still providing a framework based on existing literature that has established the physiologic benefits of exercise for these disorders.
Multiple Sclerosis (MS)
MS is a chronic inflammatory degenerative disease of the central nervous system (CNS). Although the exact cause of MS is unknown, its symptoms are associated with dysregulated autonomic immune cells, which inflame and damage essential structures in the CNS. Specifically, autoimmune dysfunction in MS damages the protective barrier—the “myelin sheath”—surrounding nerve fibers or “axons.” Demyelination of axons significantly disrupts communication within the CNS and the rest of the body. This can result in visual and oculomotor abnormalities, paresthesia like numbness or tingling, stiffness, fatigue, pain, and progressive cognitive decline. There are many therapies for MS, but no cure. It is, therefore, necessary and essential to study both the disease itself and its underlying symptom profiles to develop effective treatment and management protocols.
Evaluating the Role of Autonomic Dysfunction in MS-related Fatigue
Fatigue and symptoms of autonomic dysfunction are common daily symptoms for patient with MS, affecting up to 80% of patients. Yet, despite its prevalence and severity, the physiological bases for fatigue in particular is not well understood. In this study, patients with MS will undergo autonomic laboratory testing and symptom severity evaluation. The results of this testing will establish whether fatigue scores will differ between MS patients with and without autonomic symptoms and whether autonomic reflexes or symptoms relate to individual characteristics of MS.