Feasibility of serum CGRP measurement as a biomarker of chronic migraine: a critical reappraisal

Mi Ji Lee, Sook-Yeon Lee, Soohyun Cho, Eun-Suk Kang, Chin-Sang Chung, Mi Ji Lee, Sook-Yeon Lee, Soohyun Cho, Eun-Suk Kang, Chin-Sang Chung

Abstract

Background: Calcitonin gene-related peptide (CGRP) has been reported as elevated in chronic migraine. We aimed to validate the role of interictal serum CGRP concentration in peripheral blood samples as a biomarker of chronic migraine.

Methods: We prospectively recruited patients with episodic and chronic migraine and normal controls (NCs) in the Samsung Medical Center between August 2015 and May 2016. Blood samples were collected interictally from antecubital veins per prespecified protocol. Serum CGRP measurement was performed in the central laboratory by a single experienced technician blinded to clinical information. Migraine subtype, headache days in the previous month, and the presence and characteristics of headache at ±2 days of measurement were evaluated at every visit.

Results: A total of 156 migraineurs (106 episodic and 50 chronic) and 27 NCs were recruited in this study. Compared to NCs (75.7 ± 20.07 pg/mL) and patients with episodic migraine (67.0 ± 20.70 pg/mL), patients with chronic migraine did not show an interictal elevation of serum CGRP levels (64.9 ± 15.32 pg/mL). Serum CGRP concentration was not associated with headache status (ictal vs. interictal), migraine subtype (migraine with vs. without aura), use of preventive or acute medications, and comorbid medication overuse. Higher serum CGRP concentration did not predict treatment response in patients with chronic migraine.

Conclusions: Serum CGRP concentration may not be a feasible biomarker for chronic migraine. Further validation is necessary before CGRP can be used in the clinical practice.

Keywords: Biomarker; CGRP; Immunoassay; Migraine.

Conflict of interest statement

Ethics approval and consent to participate

The Institutional Review Board of Samsung Medical Center approved this study (2015–07-178) and each patient provided written informed consent.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Interictal serum CGRP concentration in different groups. Dots represent individual values. Red line indicates the median of each group
Fig. 2
Fig. 2
Scatterplot between interictal serum CGRP concentration and monthly headache days in all patients with migraine
Fig. 3
Fig. 3
Comparison of serum CGRP concentration between interictal vs. ictal measurement respectively in patients with EM and those with CM
Fig. 4
Fig. 4
Change in serum CGRP concentration. The responder was defined as > 50% reduction in monthly headache days after 3 months of treatment
Fig. 5
Fig. 5
Correlation between changes in monthly headache days and serum CGRP concentrations before and after 3 months. The right upper and left lower sections indicate positive correlation

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