Calcitonin Gene-Related Peptide (CGRP) and Pituitary Adenylate Cyclase-Activating Polypeptide (PACAP) in Migraine Pathogenesis

Casper Emil Christensen, Messoud Ashina, Faisal Mohammad Amin, Casper Emil Christensen, Messoud Ashina, Faisal Mohammad Amin

Abstract

Migraine is a prevalent and debilitating neurologic disorder. Advancements in understanding the underlying pathophysiological mechanisms are spearheading the effort to introduce disease-specific treatment options. In recent years this effort has largely focused on alteration of endogenous neuropeptide signaling, namely the peptides calcitonin gene-related peptide (CGRP) and pituitary adenylate cyclase-activating polypeptide (PACAP). Human studies into the pathophysiological underpinnings of CGRP and PACAP in migraine are manifold and here we review the works investigating these neuropeptides in patients suffering from migraine in order to elucidate the background for developing new treatment options for this vastly disabling disorder.

Keywords: MR-angiography; MRI; cerebral artery; headache; meningeal artery; migraine; neurovascular.

Conflict of interest statement

C.E.C. reports personal fees from Teva pharmaceuticals for lecturing and consultancy services. M.A. reported receiving personal fees from AbbVie, Allergan, Amgen, Eli Lilly, Lundbeck, Novartis, and Teva Pharmaceuticals during the conduct of the study. M.A. reported serving as Associate Editor of Cephalalgia, the Journal of Headache and Pain, and Brain. F.M.A. has received honoraria and personal fees from Teva, Lundbeck, Novartis, and Eli Lilly for lecturing or participating in advisory boards or being a principal investigator of phase IV trials. F.M.A. reported serving as associate editor of Frontiers in Pain Research and Headache Medicine, and as junior editor of Cephalalgia.

Figures

Figure 1
Figure 1
Migraine induction rates in the various provocation studies investigating migraine using calcitonin gene-related peptide (CGRP) (a), and pituitary adenylate cyclase-activating polypeptide-38 (PACAP38) (b), divided into study setups. “Active comparator” denotes the fact that each peptide was tested against another provocation model and “treatment trial” indicates that data has been extrapolated from the placebo arm of a study that sought to inhibit migraine induction by PA-CAP38.

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Source: PubMed

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