Diminished nocturnal lipolysis in cluster headache: a sign of central sympathetic dysregulation?
BACKGROUND
It is unclear whether the autonomic symptoms during cluster headache (CH) attacks are of central or peripheral origin. A metabolic change such as altered lipolysis would reflect a central autonomic dysfunction.


OBJECTIVE
To study nocturnal lipolysis in CH patients and healthy control subjects.


METHODS
Microdialysis technique was used to measure glycerol levels, the end-product of lipolysis, in subcutaneous adipose tissue. Ten CH patients participated, of whom six were studied in remission as well as during symptomatic periods but between headache attacks. Fifteen healthy control subjects were studied. Mean glycerol, glucose, and lactate concentrations were calculated for three 2-hour intervals between 2400 and 0600 hours.


RESULTS
Compared with healthy control subjects, symptomatic CH patients had lower glycerol levels during all three intervals (69, 61, and 73% of control levels; p < 0.05). CH patients in remission showed lower glycerol levels from 0200 to 0600 hours (68 and 63% of control levels; p < 0.05). There were no significant differences between the CH groups. Compared with healthy control subjects, patients in remission also showed a significantly different nocturnal temporal pattern, demonstrating declining glycerol levels during the first part of the night.


CONCLUSIONS
Altered lipolysis was found in patients with CH, both in symptomatic periods and in remission. The altered lipolysis may be due to a reduced nocturnal sympathetic activity and consequently an indication of central sympathetic dysregulation and hypothalamic dysfunction.
Meyer
Eva Laudon
EL
Department of Neurology, Karolinska Institute, Huddinge University Hospital, Stockholm, Sweden. eva.laudon-meyer@hs.se
Waldenlind
Elisabet
E
Marcus
Claude
C
D000273:Adipose Tissue / Q000378:metabolism; D000328:Adult; D002490:Central Nervous System / Q000503:physiopathology*; D002940:Circadian Rhythm; D003027:Cluster Headache / Q000175:diagnosis / Q000378:metabolism / Q000503:physiopathology*; D000431:Ethanol / Q000378:metabolism; D005260:Female; D005990:Glycerol / Q000032:analysis / Q000378:metabolism; D006801:Humans; D008066:Lipolysis; D008297:Male; D017551:Microdialysis; D008875:Middle Aged; D012016:Reference Values; D012907:Smoking / Q000378:metabolism; D013564:Sympathetic Nervous System / Q000503:physiopathology*
D000431:Ethanol; D005990:Glycerol