title: [Faulty regulation of the hypothalamo-hypophyseal-adrenal axis and chronobiological manifestations in cluster headache].
abstract: Cluster headache is a rare very severe disorder that is clinically well characterized with a relatively poorly understood pathophysiology. Although peripheral structures are postulated to be involved in triggering the pain attacks, chronobiological changes like the cluster period and the complex dysbalance of the sympathetic and parasympathetic nervous system point to a "central" genesis of cluster headache. To check neuroendocrine changes in cluster headache, in 12 patients (43.4 +/- 6.3 years) during the cluster period cortisol and ACTH were determined four-times a day (7.00, 12.00, 17.00, 23.00) in the plasma. To prove the central genesis of cluster headache, in the cerebrospinal fluid (CSF) the neurotransmitters norepinephrine, epinephrine, dopamine and the metabolites 5-hydroxyindolacetic acid (5-HIAA), homovanillic acid (HVA) and vanillymandelic acid (VMA) were determined. The values of cortisol and ACTH were significantly elevated in the morning (p < 0.01, p < 0.05) and at night (p < 0.01, p < 0.01) in comparison to the control patients. The daily mean value of cortisol was significantly increased compared to controls (p < 0.01). In the CSF norepinephrine (p < 0.05), HVA (p < 0.01) and 5-HIAA (p < 0.01) decreased to significant low levels compared to control patients. We found significant correlations between cortisol/ACTH and norepinephrine and 5-HIAA. Moreover, our results indicate that the higher cortisol the longer the duration of the cluster period. The results of this study confirm changes of the hypothalamic-pituitary-adrenal axis due to the chronobiological changes in cluster headache. The reduced values of neurotransmitters in the CSF are compatible with the hypothesis of a central genesis of cluster headache.
authors.affiliation: Abteilung Neurologie, Universität des Saarlandes, Homburg/Saar.
authors.forename: M
authors.initials: M
authors.lastname: Strittmatter
authors.forename: G
authors.initials: G
authors.lastname: Hamann
authors.forename: F
authors.initials: F
authors.lastname: Blaes
authors.forename: C
authors.initials: C
authors.lastname: Fischer
authors.forename: M
authors.initials: M
authors.lastname: Grauer
authors.forename: K H
authors.initials: KH
authors.lastname: Hoffmann
authors.forename: K
authors.initials: K
authors.lastname: Schimrigk
mesh_terms: D000324:Adrenocorticotropic Hormone / Q000097:blood; D000328:Adult; D001812:Blood-Brain Barrier / Q000502:physiology; D002940:Circadian Rhythm / Q000502:physiology*; D003027:Cluster Headache / Q000503:physiopathology*; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D007030:Hypothalamo-Hypophyseal System / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D018377:Neurotransmitter Agents / Q000134:cerebrospinal fluid; D010275:Parasympathetic Nervous System / Q000503:physiopathology; D010913:Pituitary-Adrenal System / Q000503:physiopathology*; D012016:Reference Values; D013564:Sympathetic Nervous System / Q000503:physiopathology
chemical_list: D018377:Neurotransmitter Agents; D000324:Adrenocorticotropic Hormone; D006854:Hydrocortisone