Enhanced Hemodynamic and Clinical Response to αCGRP in Migraine Patients—A TCD Study

Abstract

Introduction: Sensitisation of the nervous system in a patient with migraine is supposed to be associated with calcitonin gene-related peptide (CGRP) activity. Therefore, the vascular response to human αCGRP (hαCGRP) could be a surrogate marker for the sensitization. We hypothesize that vascular response to hαCGRP is augmented in a patient with migraine.Methods: Twenty healthy subjects and 20 patients with migraine participated in our study. TCD was used to monitor mean arterial velocity in the middle cerebral artery (vm MCA). Simultaneously, end-tidal CO2 (Et-CO2), mean arterial pressure (MAP), and heart rate (HR) were measured. The reconstruction of the signals was made for basal conditions, during and after CGRP infusion which were compared using statistics.Results: In both groups, we found significant decrease between measurement points of vm MCA and Et-CO2 during and after hαCGRP infusion. MAP did not show significant trends during the infusion, but it was significantly increased after the infusion in migraine patients only. Responses to hαCGRP, defined as differences between two measurement points, were significantly higher for vm MCA and Et-CO2 in patients with migraine. A significant difference between groups was found in MAP response. Significant relationships were found between migraine and vm MCA, Et-CO2, and MAP.Conclusion: In patients with migraine, vm MCA responses to hαCGRP are significantly higher and are associated with CGRP-induced headache which indicates that patients with migraine are more prone to sensitization.

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

“…In a previous study of our research group performed in migraineurs, 24 we found a maximal decrease in vm MCA change (point 2 of the experiment) of 67.8%, and a maximal decrease in vm PCA change of 67.1% (point 2 of the experiment), regardless of the presence of aura. After comparing migraineurs (MA and MO) to controls, 6 the maximal decrease in vm MCA change (point 2 of the experiment) was 131.1% and 45.3%, respectively.…”

CGRP Inhibitors and Oxidative Stress Biomarkers in Resistant Migraine: A Real-Life Study with Erenumab, Fremanezumab, and Galcanezumab

“…This parameter is important, as recently demonstrated during the pandemic when both physical activity levels and sleep quality dropped in migraine patients [ 23 ]. The link between oxidative stress, physical activity, and sleep quality could somehow reside in the CGRP system [ 12 , 13 , 23 ].…”

“…Hemodynamic changes related to neurotransmitters concentration, physical ac-tivity, and the associated oxidative stress are important fields of investigation in mi-graine to achieve this goal [ 12 , 13 ].…”

Cerebral Hemodynamics, Right-to-Left Shunt and White Matter Hyperintensities in Patients with Migraine with Aura, Young Stroke Patients and Controls

“…This may be due to a higher release of vasoactive substances (e.g., NO) by the endothelium or to an increased sensitivity of vessel smooth muscles as hypothesized by Olesen and Thomsen [ 64 , 65 ]. Previous studies found a greater MCA velocity reduction induced by a CGRP infusion in migraineurs than controls, suggesting that MA patients have a vascular tree that is more sensitive to neurogenic modulation of hemodynamics [ 66 , 67 ]. Other mechanisms have been hypothesized on the basis of an increased sensitization in MA patients, one of which relies on CGRP release from sensory neurons.…”