Calcitonin gene-related peptide and migraine.

Abstract

Migraine is a common, complex disorder of the brain with significant morbidity. As the pathophysiology of the disorder has become better appreciated, the role of neuropeptides has been explored. Calcitonin gene-related peptide (CGRP) has emerged as a promising therapeutic target. CGRP is widely distributed in the nervous system, particularly at anatomical areas thought to be involved with migraine, including the trigeminovascular nociceptive system. In studies, CGRP has been shown to be released during severe migraine attacks, and effective triptan treatment of an attack normalizes these levels. CGRP administration triggers migraine in patients and CGRP receptor antagonists can abort migraine. Moreover, recent data demonstrate that CGRP mechanism blockade either by small molecule receptor antagonists or by monoclonal antibodies can have a preventive effect in migraine. This article highlights the evidence behind the role of CGRP in migraine and the state of CGRP-based mechanism treatment development. We present a summary of the evidence base behind CGRP in migraine pathophysiology and the novel CGRP mechanism drugs and their potential future contribution to migraine management in our clinical practice.