Involvement of corticotrophin-releasing factor and orexin-A in chronic migraine and medication-overuse headache: Findings from cerebrospinal fluid

P. Sarchielli, I. Rainero, F. Coppola, C. Rossi, M. L. Mancini, L. Pinessi, P. Calabresi

Research output: Contribution to journalArticle

Abstract

The study set out to investigate the role of corticotrophin-releasing factor (CRF) and orexin-A in chronic migraine (CM) and medication-overuse headache (MOH). Twenty-seven patients affected by CM and 30 with MOH were enrolled. Control CSF specimens were obtained from 20 age-matched subjects who underwent lumbar puncture for diagnostic purposes, and in all of them CSF and blood tests excluded central nervous system or systemic diseases. Orexin-A and CRF were determined by radioimmunoassay methods. Significantly higher levels of orexin-A and CRF were found in the CSF of MOH and to a lesser extent in patients with CM compared with control subjects (orexin-A: P <0.001 and P <0.02; CRF: P <0.002 and P <0.0003). A significant positive correlation was also found between CSF orexin-A values and those of CRF (R = 0.71; P <0.0008), monthly drug intake group (R = 0.39; P <0.03) and scores of a self-completion 10-item instrument to measure dependence upon a variety of substances, the Leeds Dependence Questionnaire (LDQ) in the MOH group (R = 0.68; P <0.0003). The significantly higher orexin-A levels found in CM and MOH can be interpreted as a compensatory response to chronic head pain or, alternatively, as an expression of hypothalamic response to stress due to chronic pain. A potential role for orexin-A in driving drug seeking in MOH patients through activation of stress pathways in the brain can also be hypothesized.

Original languageEnglish
Pages (from-to)714-722
Number of pages9
JournalCephalalgia
Volume28
Issue number7
DOIs
Publication statusPublished - Jul 2008

Keywords

  • Cerebrospinal fluid
  • Chronic migraine
  • Corticotrophin-releasing factor
  • Medication-overuse headache
  • Orexin-A

ASJC Scopus subject areas

  • Clinical Neurology

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