title: Blunted autonomic response in cluster headache patients.
abstract: BACKGROUND
  Cluster headache (CH) is a disabling headache disorder with chronobiological features. The posterior hypothalamus is involved in CH pathophysiology and is a hub for autonomic control. We studied autonomic response to the head-up tilt table test (HUT) including heart rate variability (HRV) in CH patients and compared results to healthy controls.
  
  
  METHODS
  Twenty-seven episodic and chronic CH patients and an equal number of age-, sex- and BMI-matched controls were included. We analyzed responses to HUT in the time and frequency domain and by non-linear analysis.
  
  
  RESULTS
  CH patients have normal cardiovascular responses compared to controls but increased blood pressure. In the frequency analysis CH patients had a smaller change in the normalized low- (LF) (2.89 vs. 13.38, p < 0.05) and high-frequency (HF) (-2.86 vs. -13.38, p < 0.05) components as well as the LF/HF ratio (0.81 vs. 2.62, p < 0.05) in response to tilt. In the Poincaré plot, the change in ratio between long- and short-term variation was lower in patients (SD1/SD2, -0.05 vs. -0.17, p < 0.05).
  
  
  CONCLUSIONS
  CH patients show decreased autonomic response to HUT compared to healthy controls. This can be interpreted as dysregulation in the posterior hypothalamus and supports a theory of central autonomic mechanisms involvement in CH.
authors.affiliation: Danish Headache Center, Dept. of Neurology, Glostrup Hospital, University of Copenhagen, Denmark.
authors.forename: Mads
authors.initials: M
authors.lastname: Barloese
authors.affiliation: Coordinating Research Center, Dept. of Clinical Physiology, Frederiksberg Hospital, University of Copenhagen, Denmark.
authors.forename: Louise
authors.initials: L
authors.lastname: Brinth
authors.affiliation: Coordinating Research Center, Dept. of Clinical Physiology, Frederiksberg Hospital, University of Copenhagen, Denmark.
authors.forename: Jesper
authors.initials: J
authors.lastname: Mehlsen
authors.affiliation: Danish Center for Sleep Medicine, Dept. of Neurophysiology, Glostrup Hospital, University of Copenhagen, Denmark.
authors.forename: Poul
authors.initials: P
authors.lastname: Jennum
authors.affiliation: Dept. of Clinical Physiology, Glostrup Hospital, University of Copenhagen, Denmark.
authors.forename: Helena Inez Sofia
authors.initials: HI
authors.lastname: Lundberg
authors.affiliation: Danish Headache Center, Dept. of Neurology, Glostrup Hospital, University of Copenhagen, Denmark rigmor.jensen@regionh.dk.
authors.forename: Rigmor
authors.initials: R
authors.lastname: Jensen
mesh_terms: D000328:Adult; D000368:Aged; D001341:Autonomic Nervous System / Q000503:physiopathology*; D001794:Blood Pressure / Q000502:physiology*; D003027:Cluster Headache / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology*; D003718:Denmark / Q000453:epidemiology; D005260:Female; D006339:Heart Rate / Q000502:physiology*; D006801:Humans; D007034:Hypothalamus, Posterior / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D012907:Smoking / Q000453:epidemiology / Q000503:physiopathology; D011795:Surveys and Questionnaires; D018667:Tilt-Table Test / Q000379:methods; D055815:Young Adult
keywords: Cluster headache; autonomic dysfunction; autonomic nervous system; hypothalamus; pain