Circadian secretion of cortisol and melatonin in cluster headache during active cluster periods and remission.

Abstract

SUMMARY The cyclic nature of cluster headache warranted a study of the 24-hour rhythms of serum cortisol and melatonin. They were both altered during cluster periods as compared with periods of remission and healthy controls. The 24-hour mean and maximal cortisol levels were higher and the timing of the cortisol minimum was delayed as compared to the same patients in remission. Although there was no relation between the cortisol and melatonin levels and headaches, the rise of cortisol following many attacks might in part represent an adaptive response to pain. The nocturnal melatonin maximum was lower during cluster periods than in remission. This finding, and the dysautonomic signs during attacks, may reflect a change of the vegetative tone in a hyposympathetic direction.The cyclic nature of cluster headache and dysautonomic signs during attacks may suggest a dysfunction in the central nervous system related to rhythm-regulating centres. Recently, increasing interest has been focused on changes in hormonal biological rhythms in cluster headache patients.'-9 The pineal hormone melatonin is influenced by bright light'0 and is believed to reflect the circadian organisation of biological rhythms in several species including man. " Serum cortisol also exhibits a circadian rhythm. A functional relation between the pineal gland and the hypothalamic-pituitary-adrenal axis has been suggested.'2 13 We recently reported that the nocturnal levels of serum melatonin were lower in cluster headache during the active headache period than during the remission state.7 Decreased nocturnal serum melatonin levels in patients in an active cluster period as compared to normal healthy controls have also been reported.8 In the present paper the 24-hour rhythms of serum cortisol and melatonin were studied in cluster headache patients during active cluster periods and remissions. Furthermore, the nocturnal urinary excretion of melatonin was examined in cluster headache and healthy control subjects. Patients and methodsStudy ofserum cortisol and melatonin Patients Thirty-one cluster headache patients were admitted to the hospital for the study during the years 1981 to 1984. They were diagnosed as suffering from episodic cluster headache (n = 27) according to Ekbom'4 or as chronic cluster headache (n = 4) according to Ekbom and Olivarius."The age distribution and some anamnestic data are summarised in table 1.Serum cortisol was examined in all 31 patients. Eleven males and five females of the episodic cases were examined both during and between periods ofcluster headache. Serum melatonin was studied in 20 episodic and four chronic cluster patients. From nine of the 20 patients with episodic cluster headache data were obtained both during a cluster period and during a remission. Some data from eight out of these nine patients have been reported previously.7When examined during the remission period all patients were free of medication. During the active cluster period prophylactic therapy (methysergide, pizotifen, ergotamine tartrate) was st...

Exacerbated mechanical allodynia in rats with depression-like behavior

“…Of note is that those rats with an incorrect cannula placement did not show improvement in either immobility score or mechanical allodynia, suggesting a selective effect of melatonin within ACC. This behavioral data is also consistent with a low plasma melatonin level in WKY rats and in patients suffering from abdominal pain, idiopathic pain, neuropathic pain, or cluster headache (Waldenlind et al, 1987;Almay et al, 1987;Roberts-Thompson et al, 1988;von Knorring, Ekselius, 1994;Leone et al, 1995). It should be noted that the role of a specific MT receptor subtype was not examined in this study, because luzindole (MT2 > MT1) is not a highly selective antagonist for an MT receptor subtype.…”

The Physiology and Pharmacology of Melatonin in Humans

“…For example, in cluster headache, both a decrease of the amplitude and a phase advance of the MLT rhythm have been observed [17, 18]. …”

Melatonin therapy for headache disorders

“…Studies show a decrease in nocturnal melatonin secretion and an abolished melatonin rhythm in cluster headache patients both during and outside bouts [Chazot et al, 1984;Waldenlind et al, 1987Waldenlind et al, , 1994Leone et al, 1995].…”