Abstract
The origin of Cluster Headache (CH) is still unknown. The periodicty and presence of symptoms due to both sympathetic and parasympathetic activity suggest the involvement of central nervous system structures, particularly the hypothalamus. To investigate hypothalamic involvement in CH, we employed a neuroendocrinological approach. We observed a normal dexamethasone suppression test (DST) in all patients, increased cortisol plasma levels in remission patients at 8.00am before and at the end of the DST, while only in CH patients during cluster period did we find a reduced TSH response to TRH and a reduced night-time melatonin peak. The neuroendocrinological derangements found in CH may be consistent with hypothalamic involvement.
Sommario
L'origine della cefalea a grappolo è a tutt'oggi sconosciuta. Il tipico periodismo e la presenza di sintomi autonomici relativi sia all'attività simpatica che parasimpatica suggeriscono l'interessamento di strutture del Sistema Nervoso Centrale, in particolare dell'ipotalamo. Allo scopo di esplorare il coinvolgimento dell'ipotalamo nella cefalea a grappolo, abbiamo condotto uno studio di tipo neuroendocrino. I nostri risultati indicano che il test di soppressione al desametazone (DST) è normale nella CH, mentre i livelli ematici di cortisolo alle ore 8 di mattino, prima e dopo DST, sono più elevati nei pazienti in remissione sia nei confronti dei controlli che dei cluster in fase di grappolo. La risposta del TSH al TRH è ridotta e il picco notturno della melatonina è più basso nei pazienti solo durante il periodo di grappolo. Le alterazioni neuroendocrine rilevate sia in fase di remissione che di grappolo confortano l'ipotesi di un coinvolgimento dell'ipotalamo nella cefalea a grappolo.
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Leone, M., Frediani, F., D'Amico, D. et al. Dexamethasone suppression test, melatonin and TRH-test in cluster headache. Ital J Neuro Sci 13, 227–232 (1992). https://doi.org/10.1007/BF02224394
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DOI: https://doi.org/10.1007/BF02224394