• Mads Barloese, Poul Jennum, Nunu Lund, Stine Knudsen, Steen Gammeltoft, and Rigmor Jensen.
• Danish Headache Center, Dept. of Neurology, Glostrup Hospital, University of Copenhagen, Denmark.
• Cephalalgia. 2015 Sep 1; 35 (10): 869-76.

BackgroundCluster headache (CH) is a debilitating disorder characterized by unilateral, severe pain attacks with accompanying autonomic symptoms, often waking the patient from sleep. As it exhibits strong chronobiological traits and genetic studies have suggested a link with the hypocretin (HCRT) system, the objective of this study was to investigate HCRT-1 in CH patients.MethodsCerebrospinal fluid HCRT-1 concentration was measured in 12 chronic and 14 episodic CH patients during an active bout, and in 27 healthy controls. The patients were well characterized and clinical features compared to the HCRT concentration.ResultsWe found significantly lower HCRT levels both in chronic (p = 0.0221) and episodic CH (p = 0.0005) patients compared with controls. No significant relationship was found with other clinical features.ConclusionsThis is the first report of significantly reduced HCRT concentrations in CH patients. We speculate that decreased HCRT may reflect insufficient antinociceptive activity of the hypothalamus. The mechanism of the antinociceptive effect of HCRT is not known and requires further investigation. This study supports the hypothesis of a connection between arousal regulation and CH.© International Headache Society 2014.

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