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Monday, February 22, 2010

Calcitonin gene-related peptide involved in migraine from trigeminovascular system

A recent article points to the use of CRCP (Calcitonin gene-related peptide) antagonists to treat migraines. Levels of CGRP rise during migraine and experimentally injecting IV CRCP can provoke migraine. Two CGRP antagonists are being tested inthe study from Acta Neurol Belg. 2009 Dec;109(4):252-61.

CGRP is produced by the trigeminovascular system. Many patients who undergo treatment with a diagnostic neuromuscular orthotic frequently see migraines decreased and/or eliminated. A future area of study would be does Neuromuscular Dentistry work by decreasing CGRP release from the trigeminal nerve. I consider most problems to be input/output errors of the trigeminal nervous system. Do noxious inputs from the teeth, jaw muscles, jaw joints, and periodontal ligament cause surges in CRGP in susceptible individuals causing migraine.

PubMed abstract
Acta Neurol Belg. 2009 Dec;109(4):252-61.
CGRP antagonists: hope for a new era in acute migraine treatment.
Schelstraete C, Paemeleire K.

Department of Neurology, Ghent University Hospital, Ghent, Belgium.
Calcitonin gene-related peptide (CGRP) has a widespread distribution throughout the trigeminovascular system and other brain areas involved in migraine pathogenesis. Serum levels of CGRP are elevated during the migraine attack and return to normal with alleviation of pain. Intravenous injection of CGRP in migraineurs results in delayed headache similar to migraine. Since CGRP receptor antagonists lack direct vasoconstrictor activity, this therapeutic approach may offer advantages over the current mainstay of specific acute migraine treatment with 5-HT1B/1D receptor agonists (triptans), contra-indicated in patients with underlying cardiovascular disease. Intravenous BIBN4096BS (olcegepant) and oral MK-0974 (telcagepant), two CGRP-receptor antagonists, were safe and effective in the treatment of migraine attacks in Phase I and II trials. In a Phase III clinical trial, the efficacy of telcagepant 300 mg was comparable to that of zolmitriptan 5 mg. We intend to review the rationale for the use of CGRP-receptor antagonists, and to outline current developments and future perspectives.

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posted by Dr Shapira at 5:07 AM

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