Altered activity of the sympathetic nervous system and changes in the balance of hypophyseal, pituitary and adrenal hormones in patients with cluster headache.
Twelve patients (age 43.4 +/- 6.3 years) with episodic cluster headache (CH) were examined during the cluster period. Plasma norepinephrine levels in patients suffering from CH were significantly decreased compared with the control group (p < 0.01). There were also statistically significant correlations between norepinephrine levels and clinical features of the pain attacks including duration (r = 0.75, p < 0.05), intensity (r = 0.64, p < 0.05) and frequency (r = 0.68, p < 0.06), thereby suggesting a pathophysiological involvement of the sympathetic nervous system in CH. Increased plasma levels of plasmacortisol and ACTH in patients with CH, especially in the morning and in the evening, suggest an alteration of the feedback circuit involving the hypothalamus, the pituitary and the adrenal gland, an imbalance in the hormones related to these structures, as well as an alteration of the circadian rhythm. In addition, CH patients demonstrated significantly decreased levels of norepinephrine (p < 0.05), HVA (p < 0.01) and 5-HIAA (p < 0.01) in the cerebrospinal fluid (CSF) consistent with a central genesis of CH. These significant relationships between neurochemical parameters and the clinical patterns suggest a complex interplay between the hypothalamus, neuroendocrinological parameters, activity of the autonomic nervous system and the pain of CH.
Strittmatter
M
M
Department of Neurology, University of the Saarland, Homburg, Germany.
Hamann
G F
GF
Grauer
M
M
Fischer
C
C
Blaes
F
F
Hoffmann
K H
KH
Schimrigk
K
K
D000305:Adrenal Cortex Hormones / Q000378:metabolism*; D000324:Adrenocorticotropic Hormone / Q000097:blood; D000328:Adult; D016022:Case-Control Studies; D002395:Catecholamines / Q000097:blood / Q000134:cerebrospinal fluid; D003027:Cluster Headache / Q000378:metabolism / Q000503:physiopathology*; D005260:Female; D006719:Homovanillic Acid / Q000134:cerebrospinal fluid; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D006897:Hydroxyindoleacetic Acid / Q000134:cerebrospinal fluid; D007031:Hypothalamus / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D010907:Pituitary Hormones / Q000378:metabolism*; D013564:Sympathetic Nervous System / Q000503:physiopathology*; D014642:Vanilmandelic Acid / Q000134:cerebrospinal fluid
D000305:Adrenal Cortex Hormones; D002395:Catecholamines; D010907:Pituitary Hormones; D006897:Hydroxyindoleacetic Acid; D014642:Vanilmandelic Acid; D000324:Adrenocorticotropic Hormone; D006854:Hydrocortisone; D006719:Homovanillic Acid