Hypersensitivity to Calcitonin Gene–Related Peptide in Post-Traumatic Headache
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Hypersensitivity to Calcitonin Gene–Related Peptide in Post-Traumatic Headache. / Ashina, Håkan; Iljazi, Afrim; Al-Khazali, Haidar M.; Christensen, Casper E.; Amin, Faisal M.; Ashina, Messoud; Schytz, Henrik W.
I: Annals of Neurology, Bind 88, Nr. 6, 2020, s. 1220-1228.Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › fagfællebedømt
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TY - JOUR
T1 - Hypersensitivity to Calcitonin Gene–Related Peptide in Post-Traumatic Headache
AU - Ashina, Håkan
AU - Iljazi, Afrim
AU - Al-Khazali, Haidar M.
AU - Christensen, Casper E.
AU - Amin, Faisal M.
AU - Ashina, Messoud
AU - Schytz, Henrik W.
PY - 2020
Y1 - 2020
N2 - Objective: To demonstrate that calcitonin gene–related peptide (CGRP) induces headache exacerbation with migraine-like features in patients with persistent post-traumatic headache (PTH) attributed to mild traumatic brain injury (TBI). Methods: A randomized, double-blind, placebo-controlled, two-way crossover study was conducted. Analyses were intention-to-treat. Eligible patients were aged 18 to 65 years and had a history of persistent PTH after mild TBI for at least 12 months. Patients were randomized to receive an intravenous infusion of 1.5μg/min of CGRP or placebo (isotonic saline) over 20 minutes on two separate experimental days. A 12-hour observational period was used to evaluate the following outcomes: (1) difference in incidence of headache exacerbation with migraine-like features and (2) difference in area under the curve for headache intensity scores. Results: Thirty patients (mean age = 37 years, 25 women [83%]) were randomized and completed the study. During the 12-hour observational period, 21 of 30 patients (70%) developed headache exacerbation with migraine-like features after CGRP, compared with 6 patients (20%) after placebo (p < 0.001). The baseline-corrected area under the curve for headache intensity scores was significantly larger after CGRP, compared with placebo (p < 0.001). Interpretation: Patients with persistent PTH are hypersensitive to CGRP, which underscores its pathophysiological importance. Furthermore, CGRP-targeted therapies might provide a novel mechanism-based treatment option for patients with persistent PTH. ANN NEUROL 2020;88:1220–1228.
AB - Objective: To demonstrate that calcitonin gene–related peptide (CGRP) induces headache exacerbation with migraine-like features in patients with persistent post-traumatic headache (PTH) attributed to mild traumatic brain injury (TBI). Methods: A randomized, double-blind, placebo-controlled, two-way crossover study was conducted. Analyses were intention-to-treat. Eligible patients were aged 18 to 65 years and had a history of persistent PTH after mild TBI for at least 12 months. Patients were randomized to receive an intravenous infusion of 1.5μg/min of CGRP or placebo (isotonic saline) over 20 minutes on two separate experimental days. A 12-hour observational period was used to evaluate the following outcomes: (1) difference in incidence of headache exacerbation with migraine-like features and (2) difference in area under the curve for headache intensity scores. Results: Thirty patients (mean age = 37 years, 25 women [83%]) were randomized and completed the study. During the 12-hour observational period, 21 of 30 patients (70%) developed headache exacerbation with migraine-like features after CGRP, compared with 6 patients (20%) after placebo (p < 0.001). The baseline-corrected area under the curve for headache intensity scores was significantly larger after CGRP, compared with placebo (p < 0.001). Interpretation: Patients with persistent PTH are hypersensitive to CGRP, which underscores its pathophysiological importance. Furthermore, CGRP-targeted therapies might provide a novel mechanism-based treatment option for patients with persistent PTH. ANN NEUROL 2020;88:1220–1228.
U2 - 10.1002/ana.25915
DO - 10.1002/ana.25915
M3 - Journal article
C2 - 32959458
AN - SCOPUS:85092081314
VL - 88
SP - 1220
EP - 1228
JO - Annals of Neurology
JF - Annals of Neurology
SN - 0364-5134
IS - 6
ER -
ID: 253356797