Corticosteroids alter CGRP and melatonin release in cluster headache episodes

Neeb, Lars; Anders, Louise; Euskirchen, Philipp; Hoffmann, J.; Israel, Heike; Reuter, Uwe

doi:10.1177/0333102414539057

Cited by 57 publications

(52 citation statements)

References 36 publications

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“…In the individual studies, detailed and precise reporting would be useful for future SR‐MAs, for example, including descriptive statistics of multiple factors for each subgroup and reporting the numeric value of estimates and corresponding precision, including units. An example of factors could be, but not limiting to, the following: Geographical origin, menstrual cycle, time point(s) of blood sampling (ie, from last ictal headache phase/ beginning of the ictal headache phase, local time range), site of blood sampling, nutrient state, body mass index, comorbidities, pain intensity, headache frequency, presence of symptoms and intake of medicine, and dietary supplements 26,37,47,48,86,98‐100 . These factors might affect the exposure‐outcome association, including others not mentioned.…”

Section: Discussionmentioning

confidence: 99%

Serotonin and Neuropeptides in Blood From Episodic and Chronic Migraine and Cluster Headache Patients in Case‐Control and Case‐Crossover Settings: A Systematic Review and Meta‐Analysis

Frederiksen¹,

Dunbar

Snoer

et al. 2020

Headache

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Objective.-The aim of this systematic review and meta-analysis (SR-MA) was to identify signaling molecule profiles and blood-derived biomarkers in migraine and cluster headache (CH) patients.Background.-Currently no migraine and CH valid biomarkers are available. Blood tests based on biomarker profiles have been used to gather information about the nervous system. Such tests have not yet been established within the primary headache field.Methods.-Case-control and case-crossover studies investigating whole blood, plasma, and serum were identified worldwide. The qualitative synthesis focused on 9 signaling molecules (serotonin [5-HT], calcitonin gene-related peptide [CGRP], endothelin-1 [ET-1], neurokinin A, neurokinin B, neuropeptide Y, pituitary adenylate cyclase-activating peptide 38 [PACAP-38], substance P (SP), and vasoactive intestinal peptide) and the quantitative synthesis on 5-HT and CGRP (≥5 comparisons available). The meta-analysis was conducted using standard and 3-level random effect models.Results.-Fifty-four eligible studies were identified (87.0% migraine, 9.3% CH, 3.7% migraine, and CH), and 2768 headache patients and 1165 controls included. Comparable fluctuations of 5-HT, CGRP, ET-1, PACAP-38, and SP in blood were generally observed between migraine and CH. Significant findings were observed for some subgroups and strata, for example, higher interictal and ictal 5-HT venous blood levels (ratio of means = 1.32, 95% CI: 1.08; 1.61; ratio of means = 1.23, 95% CI: 1.01; 1.49) in episodic migraine with aura with a female-dominated case group, higher interictal CGRP blood levels in episodic migraine (ratio of means = 1.63, 95% CI: 1.18; 2.26), and chronic migraine (ratio of means = 1.89, 95% CI: 1.33; 2.68), and higher ictal CGRP blood levels (ratio of means = 1.35, 95% CI: 1.09; 1.68) in episodic migraine were observed. In most subgroups, the quantitative synthesis revealed a high degree of heterogeneity between studies in part explained by the blood sampling site, specimen source, blood specimen, and sex distribution. Other potential confounders were age, aura, study quality, menstrual cycle, and methodology (eg, storage temperature).Conclusions.-Potential migraine and CH signaling molecule profiles and biomarkers were revealed. Nevertheless, the high degree of heterogeneity between studies impedes identification of valid biomarkers but allowed us to assess the presence of confounders. Consideration of the potential confounders identified in this SR-MA might be of importance in the experimental planning of future studies. This consideration could be incorporated through establishment of specific guidelines. Abbreviations: 2SD 2 times standard deviation, 5-HIAA 5-hydroxyindoleacetic acid, 5-HT serotonin, 5-HT 1B/1D serotonin receptor 1B/1D, CC, column chromatography, CC-RIA column chromatography and radioimmunoassay, CGRP calcitonin gene-related peptide, CH cluster headache, CI confidence interval, CSF cerebrospinal fluid, CTRL controls, CV coefficient of variation, D Cook's distance, EIA enzyme immun...

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Section: Discussionmentioning

confidence: 99%

Serotonin and Neuropeptides in Blood From Episodic and Chronic Migraine and Cluster Headache Patients in Case‐Control and Case‐Crossover Settings: A Systematic Review and Meta‐Analysis

Frederiksen¹,

Dunbar

Snoer

et al. 2020

Headache

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“…For the first part of our study (MT and aMT6s levels), 29 full texts were scrutinized, and ultimately, 10 case-control studies were included (Table 1). [31][32][33][34][35][36][37][38][39][40] Quality evaluation based on the NOS is illustrated in Table 2. One article evaluating urinary melatonin was appraised as of good quality (evaluating urinary MT), 38 while the rest of the studies registered a moderate quality.…”

Section: Re Sultsmentioning

confidence: 99%

Meta‐analysis of melatonin levels in cluster headache—Review of clinical implications

et al. 2020

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Cluster headache (CH) has been associated with circadian disturbances. The present systematic review examined available evidence for the utilization of melatonin (MT) in CH prophylaxis. First, case‐control studies assessing nocturnal MT or its urine‐expelled metabolite 6‐sulfatoxymelatonin (aMT6s) in CH individuals and healthy controls (HC) were reviewed and meta‐analyzed. Secondly, the results from randomized controlled trials (RCTs) and non‐randomized studies evaluating MT’s use in the prevention of CH were discussed. Literature search included MEDLINE, EMBASE, CENTRAL, PsycINFO, trial registries, Google Scholar, and OpenGrey. Bouts and remissions were assessed separately. Ten case‐control studies (adult participants) were retrieved. Seven evaluated serum MT; meta‐analysis involved only three of them (due to deficient reporting, n: bout = 31, remission = 38, HC = 31). Results were compatible with lower nocturnal serum MT levels during bouts [bout‐HC; FE‐MD = −29.89 pg/mL, 95% CI = (−46.00, −13.78), remission‐HC; FE‐MD = −2.40 pg/mL, 95% CI = (−16.57, 21.38), bout‐remission; RE‐MD = −32.10 pg/mL, 95% CI = (−56.78, −7.42)]. Nocturnal urinary melatonin was appraised in two studies, but reporting issues impeded the capitalization of the results. Nocturnal urine aMT6s was evaluated by two studies (n: bout = 29, remission = 22, HC = 20), and pooled results were indicative of lower aMT6s concentration in CH individuals during both active and inactive periods [bout‐HC; FE‐MD = −9.63 μg/nocturnal urine collection, 95% CI = (−14.40, −4.85), remission‐HC; FE‐MD = −9.12 μg/nocturnal urine collection, 95% CI = (−14.63,‐3.62), bout‐remission; FE‐MD = −0.58 μg/nocturnal urine collection, 95% CI = (−4.58, 3.42)]. Regarding CH prophylaxis, one RCT and two non‐randomized trials were retrieved, involving a total of 41 adult CH individuals (11—episodic, 31—chronic) and rendering the deduction of any conclusions precarious. Overall, available data for the role use of MT in CH are insufficient and inconclusive. Complementary studies evaluating endogenous MT concentrations and MT administration to patients with CH are warranted.

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“…Daytime levels seem to be within normal values. After successful CH treatment with methylprednisolone, an increase of total nocturnal melatonin levels was reported . Additionally, distinct rhythmicity of melatonin excretion is recovered in the remission periods of CH .…”

Section: Discussionmentioning

confidence: 94%

No Pattern Alteration in Single Nocturnal Melatonin Secretion in Patients With Hypnic Headache: A Case–Control Study

et al. 2016

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Corticosteroids alter CGRP and melatonin release in cluster headache episodes

Abstract: Corticosteroids alter CGRP plasma and aMT6s urine levels in a cluster bout. These changes may indicate an effect of corticosteroids on trigeminal activation and hypothalamic dysfunction.

Cited by 57 publications

References 36 publications

Serotonin and Neuropeptides in Blood From Episodic and Chronic Migraine and Cluster Headache Patients in Case‐Control and Case‐Crossover Settings: A Systematic Review and Meta‐Analysis

Serotonin and Neuropeptides in Blood From Episodic and Chronic Migraine and Cluster Headache Patients in Case‐Control and Case‐Crossover Settings: A Systematic Review and Meta‐Analysis

Meta‐analysis of melatonin levels in cluster headache—Review of clinical implications

No Pattern Alteration in Single Nocturnal Melatonin Secretion in Patients With Hypnic Headache: A Case–Control Study

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