Abstract
The involvement of calcitonin gene-related peptide (CGRP) in migraine pathophysiological mechanisms is shown by the facts that CGRP can induce migraine and that two CGRP antagonists, olcegepant and telcagepant, are effective in the treatment of migraine attacks. Increase of the neuropeptide CGRP during migraine and cluster headache attacks in the extracerebral circulation as measured in the external jugular vein (EJV) has been regarded as an established fact. Then in 2005, a study, using the migraine patients as their own controls, showed; however, no changes of CGRP in EJV. For migraine there is thus some uncertainty as to whether CGRP is increased in all migraine patients and more research is needed. In contrast, there are three ‘positive’ studies in cluster headache in which both sumatriptan, O2 and spontaneous resolution normalized CGRP. The source of an increase of CGRP in EJV is most likely a ‘nervous vasodilatory drive’ in the extracranial vascular bed. It remains an enigma how the observed increase of CGRP in the EJV fits into the mechanisms of migraine and cluster headache.
Highlights
The involvement of calcitonin gene-related peptide (CGRP) in migraine pathophysiological mechanisms is CGRP is a 37-amino-acid neuropeptide, first identified in 1982 [5]
For migraine there is some uncertainty as to whether CGRP in external jugular vein (EJV) is increased in all migraine patients; and more research, preferably with the intra-patient design with repeated measurements after provocation with NTG [21], is recommended
For cluster headache there are three studies, one in spontaneous attacks [19] and two in nitroglycerin induced attacks [20, 21], which showed an increase in CGRP levels in EJV with normalisation after sumatriptan, O2 inhalation or spontaneous resolution
Summary
Calcitonin gene-related peptide in blood: is it increased in the external jugular vein during migraine and cluster headache? Received: 15 December 2008 / Accepted: 23 February 2009 / Published online: 28 March 2009 Ó The Author(s) 2009. This article is published with open access at Springerlink.com
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