ALTERED ACTIVITY OF THE SYMPATHETIC NERVOUS-SYSTEM AND CHANGES IN THEBALANCE OF HYPOPHYSEAL, PITUITARY AND ADRENAL HORMONES IN PATIENTS WITH CLUSTER HEADACHE

TWELVE patients (age 43.4+/-6.3 years) with episodic cluster headache (CH) were examined during the cluster period. Plasma norepinephrine le vels in patients suffering from CH were significantly decreased compar ed with the control group (p < 0.01). There were also statistically si gnificant correlations between norepinephrine levels and clinical feat ures of the pain attacks including duration (r = 0.75, p < 0.05), inte nsity (r = 0.64, p < 0.05) and frequency (r = 0.68, p<0.06), thereby s uggesting a pathophysiological involvement of the sympathetic nervous system in CH. Increased plasma levels of plasmacortisol and ACTH in pa tients with CH, especially in the morning and in the evening, suggest an alteration of the feedback circuit involving the hypothalamus, the pituitary and the adrenal gland, an imbalance in the hormones related to these structures, as well as an alteration of the circadian rhythm. In addition, CH patients demonstrated significantly decreased levels of norepinephrine (p < 0.05), HVA (p < 0.01) and 5-HIAA (p < 0.01) in the cerebrospinal fluid (CSF) consistent with a central genesis of CH. These significant relationships between neurochemical parameters and the clinical patterns suggest a complex interplay between the hypothal amus, neuroendocrinological parameters, activity of the autonomic nerv ous system and the pain of CH.