Steroid hormones in cluster headaches

Stillman, Mark J.

doi:10.1007/s11916-006-0027-x

Cited by 8 publications

(4 citation statements)

References 37 publications

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“…In contrast to migraine, cluster headache has traditionally been considered a male disease [150]. While the characteristic physical attributes of cluster headache patients could point to high testosterone levels, the exact opposite has been shown to be true [151]. Low testosterone levels in patients with episodic and chronic cluster headaches were first noted in the 1970ies and later reproduced [152–154].…”

Section: Resultsmentioning

confidence: 99%

Male and female sex hormones in primary headaches

et al. 2018

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BackgroundThe three primary headaches, tension-type headache, migraine and cluster headache, occur in both genders, but all seem to have a sex-specific prevalence. These gender differences suggest that both male and female sex hormones could have an influence on the course of primary headaches. This review aims to summarise the most relevant and recent literature on this topic.MethodsTwo independent reviewers searched PUBMED in a systematic manner. Search strings were composed using the terms LH, FSH, progesteron*, estrogen*, DHEA*, prolactin, testosterone, androgen*, headach*, migrain*, “tension type” or cluster. A timeframe was set limiting the search to articles published in the last 20 years, after January 1st 1997.ResultsMigraine tends to follow a classic temporal pattern throughout a woman’s life corresponding to the fluctuation of estrogen in the different reproductive stages. The estrogen withdrawal hypothesis forms the basis for most of the assumptions made on this behalf. The role of other hormones as well as the importance of sex hormones in other primary headaches is far less studied.ConclusionThe available literature mainly covers the role of sex hormones in migraine in women. Detailed studies especially in the elderly of both sexes and in cluster headache and tension-type headache are warranted to fully elucidate the role of these hormones in all primary headaches.

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Section: Resultsmentioning

confidence: 99%

Male and female sex hormones in primary headaches

et al. 2018

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“…Consequently, a pertinent question remains whether the observed blunted sympathoexcitatory response is an epiphenomenon of general hypofunction of hypothalamic nuclei, or if it reflects a fundamental pathological process. It has been theorized that diminished sympathetic drive may explain other findings in CH such as lower melatonin [ 73 , 74 , 111 ], lower testosterone [ 112 – 114 ], increased cortisol [ 115 ] (reviewed in [ 27 ]) and why manipulation of this axis with prednisone is effective in CH but not in other primary headache disorders [ 116 ]. Such a theory would need to address the unique features of CH in comparison to other primary headaches.…”

Section: Discussionmentioning

confidence: 99%

Neurobiology and sleep disorders in cluster headache

Barloese

2015

J Headache Pain

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Cluster headache is characterized by unilateral attacks of severe pain accompanied by cranial autonomic features. Apart from these there are also sleep-related complaints and strong chronobiological features. The interaction between sleep and headache is complex at any level and evidence suggests that it may be of critical importance in our understanding of primary headache disorders. In cluster headache several interactions between sleep and the severe pain attacks have already been proposed. Supported by endocrinological and radiological findings as well as the chronobiological features, predominant theories revolve around central pathology of the hypothalamus. We aimed to investigate the clinical presentation of chronobiological features, the presence of concurrent sleep disorders and the relationship with particular sleep phases or phenomena, the possible role of hypocretin as well as the possible involvement of cardiac autonomic control. We conducted a questionnaire survey on 275 cluster headache patients and 145 controls as well an in-patient sleep study including 40 CH-patients and 25 healthy controls. The findings include: A distinct circannual connection between cluster occurrence and the amount of daylight, substantially poorer sleep quality in patients compared to controls which was present not only inside the clusters but also outside, affected REM-sleep in patients without a particular temporal connection to nocturnal attacks, equal prevalence of sleep apnea in both patient and control groups, reduced levels of hypocretin-1 in the cerebrospinal fluid of patients and finally a blunted response to the change from supine to tilted position in the head-up tilt table test indicating a weakened sympathoexcitatory or stronger parasympathetic drive. Overall, these findings support a theory of involvement of dysregulation in hypothalamic and brainstem nuclei in cluster headache pathology. Further, it is made plausible that the headache attacks are but one aspect of a more complex syndrome of central dysregulation manifesting as sleep-related complaints, sub-clinical autonomic dysregulation and of course the severe attacks of unilateral headache. Future endeavors should focus on pathological changes which persist in the attack-free periods but also heed the possibility of long-lived, cluster-induced pathology.

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“…The use of steroids for chronic headache can have an abortive action on the attacks, but these drugs cannot be used as prophylactic agents, indicating their limited use [24]. In the current study, dexamethasone was used as an adjuvant abortive agent for the control of headache attacks, as clinically observed on the basis of the reduced frequency and intensity of headache attacks in Control patients.…”

Section: Discussionmentioning

confidence: 86%