Salivary CGRP can monitor the different migraine phases: CGRP (in)dependent attacks

Alpuente, Alicia; Gallardo, Victor J; Asskour, Laila; Caronna, Edoardo; Torres‐Ferrús, Marta; Pozo‐Rosich, Patricia

doi:10.1177/03331024211040467

Cited by 43 publications

(56 citation statements)

References 46 publications

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“…As CGRP is a powerful vasodilator, one possible explanation of our findings would be that GR has increased interictal secretion of endogenous perivascular CGRP than non-responders. Indeed, differences in salivary levels of CGRP between patients and controls were found not only during migraine attacks but also in the interictal phase ( 14 , 15 ). Interestingly, Greco et al assessed CM patients with overuse of medications and found that responders to the detoxification had significantly higher baseline levels of CGRP as compared to non-responders ( 16 ).…”

Section: Discussionmentioning

confidence: 99%

Cerebral Blood Flow and Other Predictors of Responsiveness to Erenumab and Fremanezumab in Migraine—A Real-Life Study

Nowaczewska

Straburzyński²,

Waliszewska‐Prosół

et al. 2022

Front. Neurol.

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IntroductionMonoclonal antibodies (mAbs) showed efficacy in migraine prevention. The aim of this study was to check if baseline clinical parameters and cerebral blood flow (CBF) measured by transcranial Doppler (TCD) may help predict mAbs efficacy.MethodsElectronic charts of migraineurs treated with erenumab or fremanezumab, with baseline TCD evaluations were collected, including data on migraine type, pain localization, monthly migraine days (MMD), medication overuse headache (MOH), mean blood flow velocity (Vm), and pulsatility index (PI) in cerebral arteries.ResultsA total of 123 patients were enrolled, mean age 38, 75 years, 87 with chronic migraine, 61 with MOH, 72 were good responders (GR), and reported ≥50% reduction in MMD, 43 ≥75% reduction in MMD. Baseline Vm values in MCAs were significantly lower in GR as compared with non-responders. MAbs responsiveness ≥50% was positively associated with unilateral pain localization (OR: 6.53, 95% CI: 2.01–23.93; p = 0.003) and HIT-6 score (OR: 1.14, 95% CI: 1.01–1.30; p = 0.036) whereas negatively associated with Vm in right MCA (OR: 0.96, 95% CI: 0.92–0.99; p = 0.012), and having no relatives with migraine (OR: 0.40, 95% CI: 0.16–0.95; p = 0.040).ConclusionsBaseline Vm in MCA is lower in mAbs GR as compared with non-responders which may reflect increased secretion of CGRP with further vasodilation in GR. Simple clinical features and baseline CBF in anterior circulation might help to predict the patient's responsiveness.

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Section: Discussionmentioning

confidence: 99%

Cerebral Blood Flow and Other Predictors of Responsiveness to Erenumab and Fremanezumab in Migraine—A Real-Life Study

Nowaczewska

Straburzyński²,

Waliszewska‐Prosół

et al. 2022

Front. Neurol.

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“…In interictal episodic migraine (EM) patients elevated (78)(79)(80) as well as unchanged CGRP levels were found in peripheral blood compared to healthy controls (71,73,77,81).…”

Section: Interictal Cgrp In Episodic Migraine Patientsmentioning

confidence: 99%

CGRP and Migraine: What Have We Learned From Measuring CGRP in Migraine Patients So Far?

Kamm

2022

Front. Neurol.

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The multi-functional neuropeptide calcitonin gene-related peptide (CGRP) plays a major role in the pathophysiology of migraine. The detection of elevated CGRP levels during acute migraine headache was the first evidence of the importance of the peptide. Since then, elevated CGRP levels have been detected not only during spontaneous and experimentally induced migraine attacks but also interictally. However, the detection of CGRP in peripheral blood shows conflicting results. In this respect, alternative detection methods are needed and have been already proposed. This article summarizes what we have learned from studies investigating CGRP in jugular and peripheral blood and reviews the latest state of research concerning the detection of CGRP in saliva and tear fluid as well as their contribution to our understanding of migraine pathophysiology.

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“…Further studies would be required to assess the utility of brinogen as a biomarker to distinguish MA from stroke. A recent study has shown that CGRP salivary levels are increased in migraine patients compared to controls, especially in ictal phase [19]. Future studies could analyze the utility of this or other migraine biomarkers to rule out stroke mimics in code stroke.…”

Section: Discussionmentioning

confidence: 99%

Migraine Aura mimicking Stroke in Code Stroke. Analysis of diagnostic prediction models.

Macias-Gómez

Suárez-Pérez

Rodríguez-Campello

et al. 2022

Preprint

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Background: Differences between migraine with aura (MA) mimicking stroke and ischemic strokes were analyzed to create a predictive diagnostic model.Methods: Prospective cohort of code strokes attended between January 2005 and June 2020 in a tertiary hospital evaluated by a vascular neurologist. Data recorded included: Place of activation, demographics, vascular risk factors, vitals, initial blood test (glucose, blood count, electrolytes, coagulation times, D-dimer, fibrinogen and C-reactive protein), initial NIHSS, door-to-onset time, and door-to-needle time. After the vascular study, diagnosis of ischemic stroke or MA was registered. Multivariate logistic regression analyses were performed to create a predictive model. Discrimination and calibration performance were assessed. A secondary aim was to describe detailed clinical and radiological data of MA cases in order to identify new predictive factors that could be used in future studies.Results: Of 3140 code strokes attended, 2424 (77.2%) were ischemic strokes and 34 (1.1%) were MA. Migraine cases were younger, more frequently females and with low prevalence of vascular risk factors. Initial NIHSS was lower in MA cases, but no differences were seen in fibrinolysis rate (30%). Blood test showed lower levels of glucose, D-dimer, and fibrinogen in MA cases. Multivariate model showed and independent association for ischemic stroke with age [OR, (95%CI):1.09, (1.07-1.12, p<0.001], male sex [OR, (95%CI):4.47, (3.80-5.13), p<0.001], initial NIHSS [OR, (95%CI):1.21, (1.07-1.34), p<0.01], and fibrinogen levels [OR, (95%CI):1.01, (1.00-1.01), p<0.05]. A model including sex and cut-off points (age>65, NIHSS>6, and fibrinogen>400mg/dL) showed a good global discrimination capacity (AUC = 0.897) but a good calibration only for extreme predicted probabilities (>98% in ischemic strokes or < 10% in MA). We did not find any differential clinical or radiological factor that could be exclusive of MA.Conclusions: A predictive model including age >65, men sex, NIHSS >6 and fibrinogen >400 mg/dL showed a good discrimination, but low calibration performance to distinguish between MA and ischemic stroke. Future studies should involve migraine biomarkers in order to improve clinical decision making.

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Salivary CGRP can monitor the different migraine phases: CGRP (in)dependent attacks

Cited by 43 publications

References 46 publications

Cerebral Blood Flow and Other Predictors of Responsiveness to Erenumab and Fremanezumab in Migraine—A Real-Life Study

Cerebral Blood Flow and Other Predictors of Responsiveness to Erenumab and Fremanezumab in Migraine—A Real-Life Study

CGRP and Migraine: What Have We Learned From Measuring CGRP in Migraine Patients So Far?

Migraine Aura mimicking Stroke in Code Stroke. Analysis of diagnostic prediction models.

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