title: Corticosteroids alter CGRP and melatonin release in cluster headache episodes.
abstract: BACKGROUND
  Calcitonin gene-related peptide (CGRP) is a marker of trigeminal activation in acute cluster headache (CH). Melatonin production is altered in CH patients and may reflect hypothalamic dysfunction. We assessed the effects of short-term CH prevention with corticosteroids on CGRP and melatonin release in a prospective observational cohort study hypothesizing that corticosteroids influence the interictal activity of both systems indicated by the change of these biomarkers.
  
  
  METHODS
  Episodic CH subjects (n = 9) in the bout and controls with multiple sclerosis (n = 6) received 1000 mg/d methylprednisolone (MPD) i.v. for three days followed by oral tapering with prednisone. We determined CGRP plasma levels in external jugular vein blood outside an attack and 6-sulfatoxymelatonin (aMT6s) - the stable metabolite of melatonin - in 12-hour day- and nighttime urine collection prior to and several times after MPD therapy and again when CH subjects were outside the bout in complete remission. CH patients recorded the frequency of attacks.
  
  
  RESULTS
  In parallel to the reduction of headache frequency, administration of corticosteroids resulted in significantly decreased CGRP plasma levels and increased nocturnal aMT6s urine excretion in CH subjects. No significant changes were observed in controls.
  
  
  CONCLUSIONS
  Corticosteroids alter CGRP plasma and aMT6s urine levels in a cluster bout. These changes may indicate an effect of corticosteroids on trigeminal activation and hypothalamic dysfunction.
authors: Department of Neurology, Charité Universitätsmedizin Berlin, Germany lars.neeb@charite.de.
authors: Lars
authors: L
authors: Neeb
authors: Department of Neurology, Charité Universitätsmedizin Berlin, Germany.
authors: Linn
authors: L
authors: Anders
authors: Department of Neurology, Charité Universitätsmedizin Berlin, Germany.
authors: Philipp
authors: P
authors: Euskirchen
authors: Department of Neurology, Charité Universitätsmedizin Berlin, Germany.
authors: Jan
authors: J
authors: Hoffmann
authors: Department of Neurology, Charité Universitätsmedizin Berlin, Germany.
authors: Heike
authors: H
authors: Israel
authors: Department of Neurology, Charité Universitätsmedizin Berlin, Germany.
authors: Uwe
authors: U
authors: Reuter
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D000328:Adult; D015740:Calcitonin Gene-Related Peptide / Q000097:blood; D003027:Cluster Headache / Q000188:drug therapy* / Q000378:metabolism; D015331:Cohort Studies; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D006801:Humans; D008297:Male; D008550:Melatonin / Q000031:analogs & derivatives / Q000378:metabolism* / Q000652:urine; D008775:Methylprednisolone / Q000627:therapeutic use; D008875:Middle Aged
chemical_list: D000305:Adrenal Cortex Hormones; C054513:6-sulfatoxymelatonin; D015740:Calcitonin Gene-Related Peptide; D008550:Melatonin; D008775:Methylprednisolone
keywords: Cluster headache; calcitonin gene-related peptide; corticosteroids; hypothalamus; melatonin; trigeminal system