Migraine is a psychobiological disorder in which a recurrent failure of opioid and adrenergic systems might occur, as plasma and CSF studies suggest. In order to elucidate the relationship between noradrenergic and opioidergic functions, the plasma β-endorphin (β-EP) response to clonidine and the cortisol response to dexamethasone were evaluated together in 25 patients suffering from migraine without aura, and with chronic tension headache (MTH). Baseline β-EP plasma levels and β-EP response to clonidine were significantly lower in MTH subjects than in controls, suggesting a postsynaptic hypothalamo-pituitary impairment. Forty-four percent of the MTH subjects showed either a lack of suppression of plasma cortisol following dexamethasone administration, or basal cortisol concentrations higher than controls and suppressors, suggesting a disinhibition of the hypothalamo-pituitary-adrenal (HPA) axis. An inverse correlation was found between pain severity and β-EP secretion induced by clonidine (Δ max), and no relationship was found between β-EP and mood. These data suggest a failure of central noradrenergic activity, or perhaps an impaired secretion of β-EP not related to HPA axis hyperactivity or to affective state.
ASJC Scopus subject areas
- Endocrinology, Diabetes and Metabolism
- Psychiatry and Mental health
- Biological Psychiatry
- Endocrine and Autonomic Systems