The short metyrapone test in chronic headache patients.

The short, overnight, metyrapone test with plasma ACTH and beta-endorphin (beta-EP) determination has been performed in patients with migraine, other forms of headache, and healthy volunteers. A rise in plasma ACTH and beta-EP after metyrapone occurred in all investigated subjects. The rate of increase varied greatly from one individual to the other, but no significant differences between the mean values of plasma ACTH and beta-EP in different groups of headache patients and volunteers were observed. Three months of nadolol therapy in migraine patients caused a significant increase in plasma ACTH and decrease in beta-EP concentrations. Findings support the view that migraine patients do not have a primary dysfunction of the hypothalamus-pituitary-adrenal (HPA) axis as demonstrated by methods currently in use.