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CGRP and the Trigeminal System in Migraine.
Smriti Iyengar1, Kirk W Johnson1, Michael H Ossipov2
1Eli Lilly and Company, Indianapolis, IN, USA.
Headache
|April 16, 2019
Summary
Calcitonin gene-related peptide (CGRP) is crucial in migraine pathophysiology. Blocking CGRP signaling in the trigeminal system effectively treats migraine and may help with cluster headaches.
Area of Science:
- Neurology
- Neuroscience
- Pharmacology
Background:
- Migraine is a common, disabling neurological disorder characterized by severe headaches.
- Despite advances, migraine remains undertreated, highlighting an unmet medical need.
- Calcitonin gene-related peptide (CGRP) has been implicated in migraine for two decades, with recent drug development focusing on its signaling pathway.
Purpose of the Study:
- To review the role of CGRP in migraine pathophysiology.
- To provide an update on CGRP's function within the trigeminovascular system.
- To discuss the implications of CGRP targeting for migraine and potentially cluster headache treatment.
Main Methods:
- Narrative review of recent (2016-2018) published articles.
- Utilized PubMed searches for original research and relevant review articles.
- Focused on studies investigating CGRP within the trigeminovascular system.
Main Results:
- CGRP is abundant in trigeminal ganglion neurons and released from nerve terminals.
- CGRP release triggers events like nitric oxide synthesis and nerve sensitization.
- Central sensitization, potentially driven by CGRP, may link episodic to chronic migraine.
Conclusions:
- CGRP is essential for migraine pathophysiology.
- Therapies targeting peripheral CGRP signaling are effective for migraine.
- Blocking CGRP may also offer benefits for cluster headache.
