Bariatric Surgery in Migraine patients: CGRP Level and Weight Loss

Etefagh, Helia Hemasian; Shahabi, Shahab; Melali, Hamid; Sayadi, Masoud; Ansari, Hossein; Shahzamani, Arvin; Deyhimi, Mitra Sadat

doi:10.1007/s11695-022-06218-2

Cited by 5 publications

(3 citation statements)

References 31 publications

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Section: Populationcontrasting

confidence: 54%

“…Although we found only a trend toward BMI effect, our study may not have been powered to detect this association that has been reported [28,38]. There is some evidence that CGRP levels decrease with bariatric surgery in obese patients [38] and these previous findings do raise the question if the levels in obese patients of CGRP may be so elevated in obese patients that dosing may not be adequate. Larger studies may be informative on this issue, and perhaps considerations done to adjust for confounders or interactions utilizing the variables we felt could have a significant effect on likelihood of response from previous analysis.…”

Section: Populationcontrasting

confidence: 54%

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Predicting CGRP-Antagonists Response Based on the Phenotypic Features of Migraine Headaches, a Retrospective Study

Awss,

Anindita,

Gary

et al. 2023

Int J Neurol Neurother

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Objective: Calcitonin-gene-related-peptide monoclonal antibodies (CGRP-MABs) are newly-introduced but widelyused treatments for migraine. We aimed to characterize some predictors of clinical response to CGRP-MABs. Methods:This was a retrospective chart review of patients started on CGRP-MABs at our academic headache practice in a 3 year-period. All patients met the criteria for migraine with or without aura, and/or chronic migraine as per the international headache classification ICHD-III.We collected demographics, migraine characteristics, phenotypical features of the headache, and response to CGRP-MABs. Responders had a 50% or more reduction in headache days. We performed multi-variate analyses and a logistic regression model to determine if any baseline characteristics or phenotypical features aided in predicting CGRP-MAB response.Results: 76 subjects were enrolled, 82% female (63/76), with a mean age of 40.2 ± 13.1. We had 64% (49/76) of the patients experience a response. Having autonomic symptoms (such as lacrimation, rhinorrhea, congestion) was associated with lower likelihood of response to CGRP MABs (OR 0.12, 95% CI [0.02 to 0.60, p = 0.015]), as was increased age with a lower effect size (OR 0.94 95% CI [0.88-0.99], p = 0.020). Increased BMI was not statistically significant as a predictor although there may have been a trend towards and effect (OR 0.40 95% CI [0.11-1.33], p = 0.142). Conclusions:The presence of autonomic symptoms in migraine headaches may predict lack of response to CGRP-MABs. This study is limited by the small sample size. However, it is biologically plausible that presence of autonomic features is predictive of a decreased response to CGRP MABs as migraine patients with autonomic symptoms have higher levels of VIP correlated to this, and not CGRP(3). Our study raises the possibility that migraines with autonomic features may be at least in part VIP driven. Larger prospective studies are needed to confirm these findings.

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Section: Populationcontrasting

confidence: 54%

Section: Populationcontrasting

confidence: 54%

Predicting CGRP-Antagonists Response Based on the Phenotypic Features of Migraine Headaches, a Retrospective Study

Awss,

Anindita,

Gary

et al. 2023

Int J Neurol Neurother

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“…This is the reason why ELISA-based studies are also subjected to the exact same issues associated with RIA-based works. As it has been described, investigations using the same brand also reports similar peptide concentration ranges [ 25 , 26 , 30 , 44 , 49 , 67 ], even though this is not always the case [ 32 ], but, most importantly, those using different kits clash in the range of concentrations [ 23 , 61 , 62 ] on top of the conclusions drawn [ 33 , 61 ]. For this point we need to explain that kits from USCN Life Sciences and Cloud Clone Corp., and from Peninsula Laboratories and BMA Biomedicals have been considered as only two brands since these companies have merged or have been acquired by the other at some point in their history.…”

Section: Discussionmentioning

confidence: 84%

Untangling the mess of CGRP levels as a migraine biomarker: an in-depth literature review and analysis of our experimental experience

Gárate,

Pascual,

Pascual-Mato

et al. 2024

J Headache Pain

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Background Calcitonin gene-related peptide (CGRP) is the most promising candidate to become the first migraine biomarker. However, literature shows clashing results and suggests a methodological source for such discrepancies. We aimed to investigate some of these methodological factors to evaluate the actual role of CGRP as biomarker. Methods Previous to the experimental part, we performed a literature review of articles measuring CGRP in migraine patients. Using our 399 bio-bank sera samples, we performed a series of experiments to test the validity of different ELISA kits employed, time of sample processing, long-term storage, sampling in rest or after moderate exercise. Analysis of in-house data was performed to analyse average levels of the peptide and the effect of sex and age. Results Literature review shows the high variability in terms of study design, determination methods, results and conclusions obtained by studies including CGRP determinations in migraine patients. CGRP measurements depends on the method and specific kit employed, also on the isoform detected, showing completely different ranges of concentrations. Alpha-CGRP and beta-CGRP had median with IQR levels of 37.5 (28.2–54.4) and 4.6 (2.4–6.4)pg/mL, respectively. CGRP content is preserved in serum within the 24 first hours when samples are stored at 4°C after clotting and immediate centrifugation. Storages at -80°C of more than 6 months result in a decrease in CGRP levels. Moderate exercise prior to blood extraction does not modulate the concentration of the peptide. Age positively correlates with beta-CGRP content and men have higher alpha-CGRP levels than women. Conclusions We present valuable information for CGRP measurements in serum. ELISA kit suitability should be tested prior to the experiments. Alpha and beta-CGRP levels should be analysed separately as they can show different behaviours even within the same condition. Samples can be processed in a 24-h window if they have been kept in 4°C and should not be stored for more than 6 months at -80°C before assayed. Patients do not need to rest before the blood extraction unless they have performed a high-endurance exercise. For comparative studies, sex and age should be accounted for as these parameters can impact CGRP concentrations. Graphical Abstract

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Evaluation of the risk of hypertension in patients treated with anti-CGRP monoclonal antibodies in a real-life study

Guerzoni,

Castro,

Brovia

et al. 2023

Neurol Sci

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Bariatric Surgery in Migraine patients: CGRP Level and Weight Loss

Cited by 5 publications

References 31 publications

Predicting CGRP-Antagonists Response Based on the Phenotypic Features of Migraine Headaches, a Retrospective Study

Predicting CGRP-Antagonists Response Based on the Phenotypic Features of Migraine Headaches, a Retrospective Study

Untangling the mess of CGRP levels as a migraine biomarker: an in-depth literature review and analysis of our experimental experience

Evaluation of the risk of hypertension in patients treated with anti-CGRP monoclonal antibodies in a real-life study

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