Interictal increase of CGRP levels in peripheral blood as a biomarker for chronic migraine

Cernuda-Morollón, Eva; Larrosa, Davinia; Ramón, César; Vega, Juan Antonio Sanchez; Martínez–Camblor, Pablo; Pascual, Julio

doi:10.1212/wnl.0b013e3182a6cb72

Cited by 381 publications

(380 citation statements)

References 32 publications

(39 reference statements)

Supporting

Mentioning

331

Contrasting

Unclassified

Order By: Relevance

“…In chronic migraine, a recent study in patients shows high levels of CGRP in the peripheral blood (measured by ELISA) as well as also in the pain-free interval when compared with healthy controls [76], suggesting that CGRP measure might be a biomarker of CM.…”

Section: Migraine Pathophysiology: the Role Of Cgrpmentioning

confidence: 98%

Anti-CGRP monoclonal antibodies in migraine: current perspectives

et al. 2016

View full text Add to dashboard Cite

Migraine is a highly disabling neurological pain disorder in which management is frequently problematic. Most abortive and preventative treatments employed are classically non-specific, and their efficacy and safety and tolerability are often unsatisfactory. Mechanism-based therapies are, therefore, needed. Calcitonin gene-related peptide (CGRP) is recognized as crucial in the pathophysiology of migraine, and new compounds that target the peptide have been increasingly explored in recent years. First tested were CGRP receptor antagonists; they proved effective in acute migraine treatment in several trials, but were discontinued due to liver toxicity in long-term administration. Monoclonal antibodies against CGRP (LY2951742, ALD-403, and LBR-101/TEV-48125) or its receptor (AMG334) were subsequently developed. As reviewed in this study, numerous phase 1 and 2 trials and preliminary results of phase 3 trials have shown a good safety/tolerability profile and efficacy in migraine prevention, especially in high frequent episodic and chronic forms. Being macromolecules, these mAbs are not suitable for oral administration; however, their intravenous or subcutaneous delivery can be performed at relatively low frequency-every month or even quarterly-which enhances patients' compliance. Although not all migraineurs respond to this treatment, and longer administration periods will be needed to assess long-term effects, the results so far obtained are extraordinarily promising. The future introduction of mAbs on the market will probably represent a turning point for prevention similar to that represented by triptans for abortive treatment in migraine.

show abstract

Section: Migraine Pathophysiology: the Role Of Cgrpmentioning

confidence: 98%

Anti-CGRP monoclonal antibodies in migraine: current perspectives

et al. 2016

View full text Add to dashboard Cite

show abstract

“…Nevertheless, with Oterino et al (2), levels of plasmatic CGRP in controls were lower, although differences were not significant, than in migraine patients. CGRP has recently been found to be a good marker for chronic migraine, but its interpretation is not trouble free (3).…”

Section: Dear Sirmentioning

confidence: 99%

In reply to Rodriguez-Osorio et al.

et al. 2014

View full text Add to dashboard Cite

In reply to Rodriguez-Osorio et al. Dear Sir,We are grateful to Rodriguez-Osorio et al. for their interest in our article. The authors compared and commented on methodological issues from their article (1) and ours. (2) It is well known that endothelial-precursor circulating cells (EPCs) are under the influence of a lot of stimuli, which might modify their number and function depending on the moment of analysis, medication or even the last bout of vascular event (in this case, migraine). We used different methodology and sampling. In this regard, even when subjects were recruited if fitting chronic or episodic migraine criteria -and we permitted other confounding factors, such as analgesics -results did not differ much from Rodriguez-Osorio et al. (1) because both investigations concluded that migraine is associated with endothelial impairment. Rodriguez-Osorio et al.(1) used a very selected sample, which is of interest for avoiding confounding factors. Some sampling differences might be responsible for differences observed at least in some results. Age is an important factor for vascular events and for number of EPCs and colony-forming units (CFUs); both, CFUs and EPCs decrease with age. Our sample was approximately 5 years younger than that of , in which controls were 6 years younger than migraine patients, although this difference was not significant, mainly because they analysed a low number of subjects. In addition, they included almost exclusively females, while we included one third of males in each clinical group. With Rodriguez-Osorio et al. (1), subjects having any common vascular risk factor were excluded; but we included some subjects having dyslipemia, smoking or hypertension in both groups, controls and cases. This is also true when explaining differences in results concerning calcitonin-gene related peptide (CGRP) determination. Nevertheless, with Oterino et al. (2), levels of plasmatic CGRP in controls were lower, although differences were not significant, than in migraine patients. CGRP has recently been found to be a good marker for chronic migraine, but its interpretation is not trouble free (3).In spite of differences such as age, common vascular factors and methodology in EPC determination, both investigations concluded that migraine induces endothelial damage. We emphasize that we observed endothelial dysfunction in a younger migraine sample, which is more comparable to that attended every day in headache-dedicated clinics.

show abstract

“…6 Despite their wide uptake and recommendation as standard care for migraine attacks, triptans do not work for all patients and their use for migraine is relatively low in the United States. 5,7 In the longitudinal American Migraine Prevalence and Prevention (AMPP) study, 18.3% of respondents used triptans; only 21.7% of respondents who were taking triptans were using them as monotherapy, while the remainder combined triptans with nonsteroidal anti-inflammatory drugs (NSAIDs; 43.3%), over-the-counter (OTC) analgesics (34.1%), or other OTC medications (34.8%). 7 This study found that triptan use was associated with higher levels of disability related to headache and higher headache frequency.…”

Section: Introductionmentioning

confidence: 99%

Diclofenac potassium for oral solution (CAMBIA^®) in the acute management of a migraine attack: clinical evidence and practical experience

Joshi

Rapoport

2017

Ther Adv Neurol Disord

View full text Add to dashboard Cite

Abstract:Migraine headache affects about 12% of Western populations and is the third most common disease worldwide (sixth in terms of disability). In 1993, triptans were introduced in the United States as a new treatment for managing migraine attacks, but their use is limited by lack of response and safety concerns in some patients. Treatment options for patients with migraine who fail or cannot tolerate triptans include switching to another medication or adding an adjunctive medication. Desirable characteristics reported by patients for acute treatment of migraine attacks include complete pain relief, fast onset of action, and no pain recurrence. Diclofenac is a nonsteroidal anti-inflammatory medication that has been established as effective for acute treatment of migraine by the American Headache Society based on available evidence. Diclofenac potassium for oral solution is rapidly absorbed, achieving maximal plasma concentrations in 15 min, which coincides with a rapid onset of effect. In a comparison of diclofenac potassium for oral solution with diclofenac potassium tablets, the solution achieved a significant reduction in headache intensity beginning at 15 min compared with 60 min for the tablet. Across randomized clinical trials, approximately 25% of patients were pain free 2 h after administration of diclofenac oral solution and the effects were maintained over a 24-h period. Diclofenac potassium for oral solution is well tolerated; the most common adverse events are dizziness and gastrointestinal complaints, with incidences similar to placebo. No serious adverse events have been reported in clinical trials of diclofenac potassium for oral solution in the acute treatment of migraine. Diclofenac oral solution may offer rapid and sustained pain relief for patients who do not achieve pain resolution with other medications. In addition, patients who experience central sensitization with allodynia may benefit from the cyclooxygenase-blocking activity of diclofenac, which is needed in this advanced phase of migraine.

show abstract

Interictal increase of CGRP levels in peripheral blood as a biomarker for chronic migraine

Abstract: Increased CGRP level measured in peripheral blood outside migraine attacks and in the absence of symptomatic medication could be a biomarker helping in the diagnosis of CM.

Cited by 381 publications

References 32 publications

Anti-CGRP monoclonal antibodies in migraine: current perspectives

Anti-CGRP monoclonal antibodies in migraine: current perspectives

In reply to Rodriguez-Osorio et al.

Diclofenac potassium for oral solution (CAMBIA^®) in the acute management of a migraine attack: clinical evidence and practical experience

Contact Info

Product

Resources

About

Interictal increase of CGRP levels in peripheral blood as a biomarker for chronic migraine

Abstract: Increased CGRP level measured in peripheral blood outside migraine attacks and in the absence of symptomatic medication could be a biomarker helping in the diagnosis of CM.

Cited by 381 publications

References 32 publications

Anti-CGRP monoclonal antibodies in migraine: current perspectives

Anti-CGRP monoclonal antibodies in migraine: current perspectives

In reply to Rodriguez-Osorio et al.

Diclofenac potassium for oral solution (CAMBIA®) in the acute management of a migraine attack: clinical evidence and practical experience

Contact Info

Product

Resources

About

Diclofenac potassium for oral solution (CAMBIA^®) in the acute management of a migraine attack: clinical evidence and practical experience