Neuroendocrine evidence of deranged noradrenergic activity in chronic migraine.
Migraine is a psychobiological disorder in which a recurrent failure of opioid and adrenergic systems might occur, as plasma and CSF studies suggest. In order to elucidate the relationship between noradrenergic and opioidergic functions, the plasma beta-endorphin (beta-EP) response to clonidine and the cortisol response to dexamethasone were evaluated together in 25 patients suffering from migraine without aura, and with chronic tension headache (MTH). Baseline beta-EP plasma levels and beta-EP response to clonidine were significantly lower in MTH subjects than in controls, suggesting a postsynaptic hypothalamo-pituitary impairment. Forty-four percent of the MTH subjects showed either a lack of suppression of plasma cortisol following dexamethasone administration, or basal cortisol concentrations higher than controls and suppressors, suggesting a disinhibition of the hypothalamopituitary-adrenal (HPA) axis. An inverse correlation was found between pain severity and beta-EP secretion induced by clonidine (delta max), and no relationship was found between beta-EP and mood. These data suggest a failure of central noradrenergic activity, or perhaps an impaired secretion of beta-EP not related to HPA axis hyperactivity or to affective state.
Martignoni
E
E
Department of Neurology, IRCCS C. Mondino, University of Pavia, Italy.
Facchinetti
F
F
Rossi
F
F
Sances
G
G
Genazzani
A R
AR
Nappi
G
G
D000328:Adult; D003000:Clonidine / Q000494:pharmacology*; D003907:Dexamethasone / Q000494:pharmacology*; D005260:Female; D006261:Headache / Q000097:blood / Q000503:physiopathology*; D006801:Humans; D006854:Hydrocortisone / Q000097:blood*; D008297:Male; D008875:Middle Aged; D008881:Migraine Disorders / Q000097:blood / Q000503:physiopathology*; D011942:Receptors, Adrenergic, alpha / Q000187:drug effects*; D001615:beta-Endorphin / Q000097:blood*
D011942:Receptors, Adrenergic, alpha; D001615:beta-Endorphin; D003907:Dexamethasone; D003000:Clonidine; D006854:Hydrocortisone