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Circulating nociceptin and CGRP in medication-overuse headache.

Signe B Munksgaard1, Csaba Ertsey2, Erik Frandsen3

  • 1Department of Neurology, Rigshospitalet-Glostrup, Danish Headache Center, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.

Acta Neurologica Scandinavica
|November 21, 2018
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Summary

Serum levels of nociceptin and calcitonin gene-related peptide (CGRP) were normal in medication-overuse headache patients, unlike in migraine. These levels did not change after detoxification, suggesting they do not drive MOH symptoms.

Keywords:
biomarkerscalcitonin gene-related peptidechronic migraineheadache pathophysiologymedication-overuse headachenociceptin

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Area of Science:

  • Neurology
  • Neuroscience
  • Pharmacology

Background:

  • Previous research indicated low nociceptin and high calcitonin gene-related peptide (CGRP) in migraine patients.
  • Medication-Overuse Headache (MOH) shares features with chronic migraine, prompting investigation into similar neuropeptide alterations.
  • CGRP is known to trigger migraine-like headaches.

Purpose of the Study:

  • To investigate serum nociceptin and CGRP levels in patients with Medication-Overuse Headache (MOH).
  • To determine if these neuropeptide levels differ between MOH patients and healthy controls.
  • To assess if serum nociceptin and CGRP levels normalize after a detoxification program in MOH patients.

Main Methods:

  • A cohort of 17 MOH patients (70.6% with chronic migraine) and 30 age/sex-matched controls were studied.
  • MOH patients underwent a 2-month outpatient detoxification program.
  • Serum samples were collected at baseline and after 6 months for blinded analysis of nociceptin and CGRP levels.

Main Results:

  • No significant differences in serum nociceptin or CGRP levels were found between MOH patients and controls.
  • Following a 6-month detoxification period, headache frequency reduced by 43% in MOH patients, with 70% reverting to episodic headache.
  • Despite clinical improvement, serum nociceptin and CGRP levels remained unchanged in MOH patients post-detoxification.

Conclusions:

  • Contrary to findings in migraine, MOH patients exhibit normal serum levels of nociceptin and CGRP.
  • Altered nociceptin and CGRP levels do not appear to be the cause of increased headache frequency in MOH.
  • The study highlights the importance of identifying and treating medication overuse in chronic headache management.