Calcitonin gene‐related peptide‐induced hemodynamic changes in migraine with and without aura

Zupan, Matija; Zaletel, Marjan; Visočnik, Darja; Žvan, Bojana

doi:10.1111/ane.13495

Cited by 4 publications

(6 citation statements)

References 26 publications

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“…One study found an increase of MABP with 11% after CGRP. The mean V MCA was decreased with 9.5%-21% (11,15,16,19,21) and the diameter of the STA was dilated with 41%-43%. Based on the blood flow velocity decrease, Lassen et al (16) estimated the dilation of the MCA to be 7.5%, given that the total blood flow is constant.…”

Section: Resultsmentioning

confidence: 92%

“…The database search identified 386 citations after removing duplicates. Through manual screening of title, abstract and full text review of relevant articles, 11 studies met the inclusion criteria and were included in Scheme 1 (11,12,(15)(16)(17)(18)(19)(20)(21)(22)(23). Data following infusion of h-α-CGRP, but not placebo, was included (Tables 1-3).…”

Section: Resultsmentioning

confidence: 99%

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The vascular role of CGRP: a systematic review of human studies

et al. 2023

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Intravenous infusion of human alpha calcitonin gene-related peptide (h-α-CGRP) has been applied to explore migraine pathogenesis and cerebral hemodynamics during the past three decades. Cumulative data implicate h-α-CGRP in regulating the vascular tone. In this systematic review, we searched PubMed and EMBASE for clinical studies investigating the vascular changes upon intravenous infusion of h-α-CGRP in humans. A total of 386 studies were screened by title and abstract. Of these, 11 studies with 61 healthy participants and 177 participants diagnosed with migraine were included. Several studies reported hemodynamic effects including flushing, palpitation, warm sensation, heart rate (HR), mean arterial blood pressure (MABP), mean blood flow velocity of middle cerebral artery (mean VMCA), and diameter of superficial temporal artery (STA). Upon the start of h-α-CGRP infusion, 163 of 165 (99%) participants had flushing, 98 of 155 (63%) participants reported palpitation, and 160 of 165 (97%) participants reported warm sensation. HR increased with 14%–58% and MABP decreased with 7%–12%. The mean VMCA was decreased with 9.5%–21%, and the diameter of the STA was dilated with 41%–43%. The vascular changes lasted from 20 to >120 min. Intravenous infusion of h-α-CGRP caused a universal vasodilation without any serious adverse events. The involvement of CGRP in the systemic hemodynamic raises concerns regarding long-term blockade of CGRP in migraine patients with and without cardiovascular complications.

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Section: Resultsmentioning

confidence: 92%

Section: Resultsmentioning

confidence: 99%

The vascular role of CGRP: a systematic review of human studies

et al. 2023

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“…On the other side, an enhanced response of vm MCA is observed in migraine with a positive relationship between vm MCA responses and migraine (11). According to the previous explanation, hemodynamic changes in cerebral circulation after CGRP infusion are attributed to an enhanced vasodilatation of proximal large arteries in migraine (12). Thus, the vm MCA can be used for discrimination of migranous susceptible to CGRP from others, migranours and non-migranours.…”

Section: Methodology For Cgrp Testingmentioning

confidence: 88%

CGRP-induced headache and hemodynamic response for prediction of therapy based on CGRP antagonism

Zaletel

2023

Rad Hrvatske akademije znanosti i umjetnosti

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Migraine is increasingly recognized as a disorder of the calcitonin gene-related peptide (CGRP) pathway. However, other factors are involved in migraine pathophysiology such as vasoactive intestinal peptide (VIP) and PACAP-38. Indeed, the CGRP-test can discriminate migraine from non-migraine and other non-CGRP induced migraine using CGRP-induced headache (CGRP-IH) and cerebral hemodynamic changes. Recent studies support the evidence of CGRP susceptible migraine prone to CGRP antagonism. Therefore, the CGRP-test may have an important role in therapeutic decisions regarding anti-CGRP monoclonal antibodies and gepants. This may improve the clinical effects of CGRP antagonism in migraine patients and increase therapeutic adherence. From the perspective of pain medicine may improve placebo response which can enhance favourable therapeutic outcomes.

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“…A recent scientific concept predicted CSD as an initial event for trigeminal activation, but it does not explain the connection between CGRP and the aura ( 7 ). In our previous works, we used exogenous CGRP to provoke a hemodynamic response in the anterior and posterior cerebral circulations ( 8 , 9 ). The hemodynamic responses of MCA and PCA were used because we considered them as indicators of neural activity and sensitization during migraine attacks due to the trigeminovascular reflex (TVR).…”

Section: Introductionmentioning

confidence: 99%

“…The hemodynamic responses of MCA and PCA were used because we considered them as indicators of neural activity and sensitization during migraine attacks due to the trigeminovascular reflex (TVR). In the first study, we did not explore the magnitude of the hemodynamic responses separately for migraine with aura (MA) and migraine without aura (MO), but the results of our recent study suggest differences in the vascular responses between MO and MA ( 9 ). However, it is still not clear whether MO and MA show differences in the response's magnitude in the anterior and posterior cerebral circulation.…”

Section: Introductionmentioning

confidence: 99%

The Vasodilatory Response to CGRP of the Anterior and Posterior Cerebral Circulation in Migraine

et al. 2022

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IntroductionMigraine aura can be associated with headache or it may occur without one, which suggests an independent mechanism for the aura and for migraine headache. The role of CGRP in migraine headache is well established, but the connection between CGRP and the aura is still lacking an explanation. Exogenous CGRP can induce CGRP headaches and migraine auras in patients with migraine. The results of our recent study suggest differences in the vascular response to CGRP stimulation between migraine without aura and migraine with aura. Therefore, we hypothesized that the magnitude of the posterior cerebral circulation response in migraine with aura is greater than in migraine without aura and that CGRP stimulation has different effects on the anterior and posterior circulation in migraine with aura and migraine without aura.MethodsBy using transcranial doppler, we studied the hemodynamic effects of CGRP intravenous infusion at a rate of 1.5 mcg/min in 20 min on the mean arterial velocity in the middle cerebral artery and in the posterior cerebral artery in twenty patients with migraine and in a control group of twenty healthy subjects. The same CGRP effects on cerebral hemodynamics were analyzed separately for the group of patients with migraine with aura and the group of patients with migraine without aura. Fifteen patients with migraine (75%) had migraine without aura and 5 patients (25%) had migraine with aura.ResultsWe found that migraine has a significant impact on the vasodilatory response of the anterior (B = 4,249, SE = 1.023, r = 0.363, p < 0.001) and posterior cerebral circulation (B = 3.634, SE = 1.461, r = 0.227, p = 0.014). Migraine with aura was significantly associated with changes in the anterior (B = 2.558, SE = 0.880, r = 0.275, p = 0.005) and posterior cerebral circulation (B = 7.565, SE = 2,368, r = 0.359, p = 0.002), while migraine without aura was only significantly associated with changes in the anterior circulation. In addition, we established a significant impact of migraine with aura on VR PCA (B = 5.901, SE = 2,546, r = 0.291, p = 0.024).ConclusionWe conclude that TVR in the posterior cerebral circulation might be enhanced in MA and that aura might be a consequence of TVR enhancement.

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Calcitonin gene‐related peptide‐induced hemodynamic changes in migraine with and without aura

Cited by 4 publications

References 26 publications

The vascular role of CGRP: a systematic review of human studies

The vascular role of CGRP: a systematic review of human studies

CGRP-induced headache and hemodynamic response for prediction of therapy based on CGRP antagonism

The Vasodilatory Response to CGRP of the Anterior and Posterior Cerebral Circulation in Migraine

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