Strittmatter M, Hamann G, Blaes F, Fischer C, Grauer M, Hoffmann K H, Schimrigk K
Abteilung Neurologie, Universität des Saarlandes, Homburg/Saar.
Fortschr Neurol Psychiatr. 1997 Jan;65(1):1-7.
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.
丛集性头痛是一种罕见的极为严重的疾病，其临床特征明显，但病理生理学却相对难以理解。尽管推测周围结构参与引发疼痛发作，但诸如丛集期等生物钟变化以及交感和副交感神经系统的复杂失衡表明丛集性头痛的发病根源在“中枢”。为了检查丛集性头痛患者的神经内分泌变化，对12名患者（43.4±6.3岁）在丛集期每天测定4次（7:00、12:00、17:00、23:00）血浆中的皮质醇和促肾上腺皮质激素。为了证明丛集性头痛的中枢发病根源，测定了脑脊液中的神经递质去甲肾上腺素、肾上腺素、多巴胺以及代谢产物5-羟吲哚乙酸（5-HIAA）、高香草酸（HVA）和香草扁桃酸（VMA）。与对照患者相比，皮质醇和促肾上腺皮质激素的值在早晨（p<0.01，p<0.05）和夜间（p<0.01，p<0.01）显著升高。皮质醇的每日平均值与对照组相比显著升高（p<0.01）。与对照患者相比，脑脊液中的去甲肾上腺素（p<0.05）、HVA（p<0.01）和5-HIAA（p<0.01）降至显著低水平。我们发现皮质醇/促肾上腺皮质激素与去甲肾上腺素和5-HIAA之间存在显著相关性。此外，我们的结果表明皮质醇水平越高，丛集期持续时间越长。本研究结果证实了丛集性头痛中生物钟变化导致下丘脑-垂体-肾上腺轴的改变。脑脊液中神经递质值的降低与丛集性头痛中枢发病根源的假说相符。
