Abstract
Objective: The role of Calcitonin G related peptide (CGRP) in migraine has been demonsrated. The aim of this study was to examine the role of Adrenomedullin (AM) which is a member of the calcitonin/CGRP/amylin family in migraine patients during naturel attack and attack free period. Material and Methods: 26 migraine patients (11 with aura, 15 without aura) and 26 healty participants were involved. Blood samples were obtained from each patient in attack and attack free period, then compared with each other and control group. Results: Mean plasma AM levels were 18.95 pmol/L during migraine attacks, 26.01 pmol/L between attacks, and 33.38 pmol/L in the control group. AM levels of migraine patients were significantly lower than controls during non-attack periods (p=0.001) and more interestingly, it further decreased during attack periods (p=0.001). A comparison of the mean plasma AM levels of migraine with and without aura cases revealed the same statistically significant difference (p=0.00). Conclusion: The persistently low AM levels in migraine patients gave the impression that in physiological conditions there may be a balance between CGRP and AM and this may be changed towards to the site of CGRP in migraine pathophysiology while causing a decline in AM levels as we had found. Further studies regarding on AM involvement in migraine pathophysiology are needed to confirm these results.
Highlights
Pivotal role of Calcitonin gene related peptide (CGRP) in migraine mechanisms has been recognized long ago [1,2,3,4]
AM levels of migraine patients were significantly lower than controls during non-attack periods (p=0.001) and more interestingly, it further decreased during attack periods (p=0.001)
Due to its similarities to CGRP, AM was suggested to have a possible role in migraine pathophysiology [12]
Summary
Pivotal role of Calcitonin gene related peptide (CGRP) in migraine mechanisms has been recognized long ago [1,2,3,4]. About 20 years ago, Goadsby et al [1] reported higher serum CGRP levels in the internal jugular vein blood during migraine attacks, but another study couldn’t verify these results [7]. Due to these conflicting results it is still uncertain whether serum CGRP levels change during the natural course of migraine attack [8]. Animal studies have all shown the vasodilator effect of AM and increase in cerebral blood flow (CBF) [10,13].
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