OPIOID AND SYMPATHETIC NERVOUS-SYSTEM ACTIVITY IN CLUSTER HEADACHE UNDER VERAPAMIL OR PREDNISONE TREATMENT

This study was undertaken to evaluate the effect of treatment with pre dnisone or verapemil on plasma met-enkephalin (ME), neutrophil met-enk ephalin containing peptides (NMECP) and free and conjugated plasma cat echolamines (CA) in cluster headache (CH) patients. After obtaining a basal sample, patients were randomly selected to be treated with eithe r verapamil (n=5) or prednisone (n=5). A second blood sample was obtai ned 10 days after starting treatment. At this time all patients were f ree of symptoms. ME (0.49 +/- 0.10 pmol/mL) and NMECP (35.1 +/- 2.4 pm ol/mg protein) levels after prednisone treatment were significantly hi gher (P<0.05) than in basal conditions (0.23 +/- 0.08 pmol/mL and 27.1 4 +/- 2.4 pmol/mg protein), while no differences were found in catecho lamine levels. No differences in ME, NMECP or CA were found during ver apamil treatment. Our results suggest that in CH the two drugs act thr ough different mechanisms. The relief of the bout obtained with predni sone may be related to the opioid system stimulation observed in these patients.