EFFECT OF SULPIRIDE OR PAROXETINE ON CEREBROSPINAL-FLUID NEUROPEPTIDECONCENTRATIONS IN PATIENTS WITH CHRONIC TENSION-TYPE HEADACHE

In lumbar cerebrospinal fluid (CSF) obtained from patients with chroni c tension-type headache (CTH), the concentrations of beta-endorphin, m et-enkephalin, dynorphin, cholecystokinin (CCK), calcitonin gene-relat ed peptide (CGRP), and somatostatin were measured before and after 8 w eeks of treatment with sulpiride or paroxetine. We previously reported higher than normal met-enkephalin concentrations in CTH. The present study reveals normal basal concentrations of CCK, CGRP and somatostati n and slightly decreased dynorphin in the same patients. Treatment wit h sulpiride or paroxetine did not change the concentration of any of t he neuropeptides measured. These data suggest central changes in opioi d systems but not in other peptide systems (CCK, CGRP, somatostatin) i nvolved in nociceptive processing at the level of the spinal cord dors al horn/nucleus caudalis of the trigeminal nerve in CTH. Such central changes might be pathophysiologically important or merely secondary to other more important occurrences. The lack of changes in neuropeptide concentrations during drug treatment makes planning of studies involv ing CSF analysis easier, but also limits the probability of obtaining information on specific neuropeptide systems through CSF analysis.