The Trigeminovascular Pathway: Role of CGRP and CGRP Receptors in Migraine
TLDR
There is still much to learn about the role of CGRP and C GRP receptors in headache pathophysiology, the critical anatomical sites, peripheral or central, of anti‐CGRP agents, and the potential involvement of CgrP‐related peptides and receptors.Abstract:
The trigeminal ganglion plays a key role in primary headache pathophysiology. Calcitonin gene-related peptide (CGRP) and CGRP receptors are expressed in trigeminal neurons that form C-fibers and A-fibers, respectively. In acute migraine and cluster headache attacks, there is release of CGRP into the cranial venous outflow. In addition, intravenous CGRP can induce migraine-like symptoms in migraine patients. These findings led to the development of anti-migraine therapies that inhibit CGRP action. Currently, CGRP receptor antagonists, the gepants, and monoclonal antibodies towards CGRP and the CGRP receptor are all showing positive relief of acute and chronic migraine in clinical trials. However, there is still much to learn about the role of CGRP and CGRP receptors in headache pathophysiology, the critical anatomical sites, peripheral or central, of anti-CGRP agents, and the potential involvement of CGRP-related peptides and receptors. This review provides a brief history of the discovery of the role of CGRP in migraine and highlights current progress in understanding the complexity of the trigeminovascular pathway and its peptide transmitters.read more
Citations
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CGRP as the target of new migraine therapies — successful translation from bench to clinic
Lars Edvinsson,Lars Edvinsson,Kristian Agmund Haanes,Karin Warfvinge,Karin Warfvinge,Diana N. Krause,Diana N. Krause +6 more
TL;DR: Treatments that target calcitonin gene-related peptide (CGRP) and its receptor are proving effective for migraine treatment, and the hypothesis that CGRP has a major role in migraine pathophysiology is strongly supported.
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CGRP and the Trigeminal System in Migraine.
TL;DR: The goal of this narrative review is to provide an overview of migraine pathophysiology, with an emphasis on the role of calcitonin gene‐related peptide (CGRP) within the context of the trigeminovascular system.
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Does inflammation have a role in migraine
TL;DR: It is proposed that the increase in migraine frequency leading to chronic migraine involves neurogenic neuroinflammation, possibly entailing increased expression of cytokines via activation of protein kinases in neurons and glial cells of the trigeminovascular system.
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The Molecular Fingerprint of Dorsal Root and Trigeminal Ganglion Neurons
TL;DR: This work isolated lumbar DRG and TG neurons from Advillin-GFP transgenic mice and identified 24 genes which were uniquely expressed in either ganglia, giving each population a distinct molecular fingerprint.
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Efficacy and safety of calcitonin-gene-related peptide binding monoclonal antibodies for the preventive treatment of episodic migraine – an updated systematic review and meta-analysis
TL;DR: The current body of evidence reveals that CGRP mAb is an effective and safe preventive treatment for episodic migraine.
References
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