151
|
Abushik PA, Bart G, Korhonen P, Leinonen H, Giniatullina R, Sibarov DA, Levonen AL, Malm T, Antonov SM, Giniatullin R. Pro-nociceptive migraine mediator CGRP provides neuroprotection of sensory, cortical and cerebellar neurons via multi-kinase signaling. Cephalalgia 2016; 37:1373-1383. [PMID: 27884929 DOI: 10.1177/0333102416681588] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background Blocking the pro-nociceptive action of CGRP is one of the most promising approaches for migraine prophylaxis. The aim of this study was to explore a role for CGRP as a neuroprotective agent for central and peripheral neurons. Methods The viability of isolated rat trigeminal, cortical and cerebellar neurons was tested by fluorescence vital assay. Engagement of Nrf2 target genes was analyzed by qPCR. The neuroprotective efficacy of CGRP in vivo was tested in mice using a permanent cerebral ischemia model. Results CGRP prevented apoptosis induced by the amino acid homocysteine in all three distinct neuronal populations. Using a set of specific kinase inhibitors, we show the role of multi-kinase signaling pathways involving PKA and CaMKII in neuronal survival. Forskolin triggered a very similar signaling cascade, suggesting that cAMP is the main upstream trigger for multi-kinase neuroprotection. The specific CGRP antagonist BIBN4096 reduced cellular viability, lending further support to the proposed neuroprotective function of CGRP. Importantly, CGRP was neuroprotective against permanent ischemia in mice. Conclusion Our data show an unexpected 'positive' role for the endogenous pro-nociceptive migraine mediator CGRP, suggesting more careful examination of migraine prophylaxis strategy based on CGRP antagonism although it should be noted that homocysteine induced apoptosis in primary neuronal cell culture might not necessarily reproduce all the features of cell loss in the living organism.
Collapse
Affiliation(s)
- Polina A Abushik
- 1 Department of Neurobiology, University of Eastern Finland, Kuopio, Finland.,2 Sechenov Institute of Evolutionary Physiology and Biochemistry of the Russian Academy of Sciences, Laboratory of Comparative Neurophysiology, Saint-Petersburg, Russia
| | - Geneviève Bart
- 1 Department of Neurobiology, University of Eastern Finland, Kuopio, Finland
| | - Paula Korhonen
- 1 Department of Neurobiology, University of Eastern Finland, Kuopio, Finland
| | - Hanna Leinonen
- 3 Department of Biotechnology and Molecular Medicine, University of Eastern Finland, Kuopio, Finland
| | - Raisa Giniatullina
- 1 Department of Neurobiology, University of Eastern Finland, Kuopio, Finland
| | - Dmitry A Sibarov
- 2 Sechenov Institute of Evolutionary Physiology and Biochemistry of the Russian Academy of Sciences, Laboratory of Comparative Neurophysiology, Saint-Petersburg, Russia
| | - Anna-Liisa Levonen
- 3 Department of Biotechnology and Molecular Medicine, University of Eastern Finland, Kuopio, Finland
| | - Tarja Malm
- 1 Department of Neurobiology, University of Eastern Finland, Kuopio, Finland
| | - Sergei M Antonov
- 2 Sechenov Institute of Evolutionary Physiology and Biochemistry of the Russian Academy of Sciences, Laboratory of Comparative Neurophysiology, Saint-Petersburg, Russia
| | - Rashid Giniatullin
- 1 Department of Neurobiology, University of Eastern Finland, Kuopio, Finland.,4 Laboratory of Neurobiology, Department of Physiology, Kazan Federal University, Kazan, Russia
| |
Collapse
|
152
|
Kirkpatrick DR, McEntire DM, Smith TA, Dueck NP, Kerfeld MJ, Hambsch ZJ, Nelson TJ, Reisbig MD, Agrawal DK. Transmission pathways and mediators as the basis for clinical pharmacology of pain. Expert Rev Clin Pharmacol 2016; 9:1363-1387. [PMID: 27322358 PMCID: PMC5215101 DOI: 10.1080/17512433.2016.1204231] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Mediators in pain transmission are the targets of a multitude of different analgesic pharmaceuticals. This review explores the most significant mediators of pain transmission as well as the pharmaceuticals that act on them. Areas covered: The review explores many of the key mediators of pain transmission. In doing so, this review uncovers important areas for further research. It also highlights agents with potential for producing novel analgesics, probes important interactions between pain transmission pathways that could contribute to synergistic analgesia, and emphasizes transmission factors that participate in transforming acute injury into chronic pain. Expert commentary: This review examines current pain research, particularly in the context of identifying novel analgesics, highlighting interactions between analgesic transmission pathways, and discussing factors that may contribute to the development of chronic pain after an acute injury.
Collapse
Affiliation(s)
- Daniel R. Kirkpatrick
- Departments of Clinical and Translational Science and Anesthesiology, Creighton University School of Medicine, Omaha, NE 68178 USA
| | - Dan M. McEntire
- Departments of Clinical and Translational Science and Anesthesiology, Creighton University School of Medicine, Omaha, NE 68178 USA
| | - Tyler A. Smith
- Departments of Clinical and Translational Science and Anesthesiology, Creighton University School of Medicine, Omaha, NE 68178 USA
| | - Nicholas P. Dueck
- Departments of Clinical and Translational Science and Anesthesiology, Creighton University School of Medicine, Omaha, NE 68178 USA
| | - Mitchell J. Kerfeld
- Departments of Clinical and Translational Science and Anesthesiology, Creighton University School of Medicine, Omaha, NE 68178 USA
| | - Zakary J. Hambsch
- Departments of Clinical and Translational Science and Anesthesiology, Creighton University School of Medicine, Omaha, NE 68178 USA
| | - Taylor J. Nelson
- Departments of Clinical and Translational Science and Anesthesiology, Creighton University School of Medicine, Omaha, NE 68178 USA
| | - Mark D. Reisbig
- Departments of Clinical and Translational Science and Anesthesiology, Creighton University School of Medicine, Omaha, NE 68178 USA
| | - Devendra K. Agrawal
- Departments of Clinical and Translational Science and Anesthesiology, Creighton University School of Medicine, Omaha, NE 68178 USA
| |
Collapse
|
153
|
Goadsby PJ. Bench to bedside advances in the 21st century for primary headache disorders: migraine treatments for migraine patients. Brain 2016; 139:2571-2577. [PMID: 27671024 DOI: 10.1093/brain/aww236] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
|
154
|
Schulte LH, May A. Functional Neuroimaging in Migraine: Chances and Challenges. Headache 2016; 56:1474-1481. [DOI: 10.1111/head.12944] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2015] [Indexed: 12/16/2022]
Affiliation(s)
- Laura H. Schulte
- Department of Systems Neuroscience and Headache Outpatient Department; University Medical Center Eppendorf; Hamburg Germany
| | - Arne May
- Department of Systems Neuroscience and Headache Outpatient Department; University Medical Center Eppendorf; Hamburg Germany
| |
Collapse
|
155
|
Cernuda-Morollón E, Riesco N, Martínez-Camblor P, Serrano-Pertierra E, García-Cabo C, Pascual J. No Change in Interictal PACAP Levels in Peripheral Blood in Women With Chronic Migraine. Headache 2016; 56:1448-1454. [DOI: 10.1111/head.12949] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/01/2016] [Indexed: 01/03/2023]
Affiliation(s)
- Eva Cernuda-Morollón
- Neuroscience Area, Service of Neurology; University Hospital Central de Asturias, Oviedo and Ineuropa; Oviedo (E. Cernuda-Morollón, N. Riesco, E. Serrano-Pertierra, C. García-Cabo, and J. Pascual)
| | - Nuria Riesco
- Neuroscience Area, Service of Neurology; University Hospital Central de Asturias, Oviedo and Ineuropa; Oviedo (E. Cernuda-Morollón, N. Riesco, E. Serrano-Pertierra, C. García-Cabo, and J. Pascual)
| | - Pablo Martínez-Camblor
- Oficina de Investigación Biosanitaria OIB, Oviedo, Asturias, Spain; Universidad Autónoma de Chile; Santiago, Chile (P. Martínez-Camblor)
| | - Esther Serrano-Pertierra
- Neuroscience Area, Service of Neurology; University Hospital Central de Asturias, Oviedo and Ineuropa; Oviedo (E. Cernuda-Morollón, N. Riesco, E. Serrano-Pertierra, C. García-Cabo, and J. Pascual)
| | - Carmen García-Cabo
- Neuroscience Area, Service of Neurology; University Hospital Central de Asturias, Oviedo and Ineuropa; Oviedo (E. Cernuda-Morollón, N. Riesco, E. Serrano-Pertierra, C. García-Cabo, and J. Pascual)
| | - Julio Pascual
- Neuroscience Area, Service of Neurology; University Hospital Central de Asturias, Oviedo and Ineuropa; Oviedo (E. Cernuda-Morollón, N. Riesco, E. Serrano-Pertierra, C. García-Cabo, and J. Pascual)
- University Hospital Marqués de Valdecilla and IDIVAL; Santander Spain (J. Pascual)
| |
Collapse
|
156
|
Salameh TS, Rhea EM, Banks WA, Hanson AJ. Insulin resistance, dyslipidemia, and apolipoprotein E interactions as mechanisms in cognitive impairment and Alzheimer's disease. Exp Biol Med (Maywood) 2016; 241:1676-83. [PMID: 27470930 PMCID: PMC4999626 DOI: 10.1177/1535370216660770] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
An increased risk for Alzheimer's disease is associated with dyslipidemia and insulin resistance. A separate literature shows the genetic risk for developing Alzheimer's disease is strongly correlated to the presence of the E4 isoform of the apolipoprotein E carrier protein. Understanding how apolipoprotein E carrier protein, lipids, amyloid β peptides, glucose, central nervous system insulin, and peripheral insulin interact with one another in Alzheimer's disease is an area of increasing interest. Here, we will review the evidence relating apolipoprotein E carrier protein, lipids, and insulin action to Alzheimer's disease and Aβ peptides and then propose mechanisms as to how these factors might interact with one another to impair cognition and promote Alzheimer's disease.
Collapse
Affiliation(s)
- Therese S Salameh
- Geriatric Research, Education, and Clinical Center, Veterans Affairs Puget Sound Health Care System, Seattle, WA 98108, USA Division of Gerontology and Geriatric Medicine, Department of Medicine, University of Washington School of Medicine, Seattle, WA 98195, USA
| | - Elizabeth M Rhea
- Geriatric Research, Education, and Clinical Center, Veterans Affairs Puget Sound Health Care System, Seattle, WA 98108, USA Division of Gerontology and Geriatric Medicine, Department of Medicine, University of Washington School of Medicine, Seattle, WA 98195, USA
| | - William A Banks
- Geriatric Research, Education, and Clinical Center, Veterans Affairs Puget Sound Health Care System, Seattle, WA 98108, USA Division of Gerontology and Geriatric Medicine, Department of Medicine, University of Washington School of Medicine, Seattle, WA 98195, USA
| | - Angela J Hanson
- Geriatric Research, Education, and Clinical Center, Veterans Affairs Puget Sound Health Care System, Seattle, WA 98108, USA Division of Gerontology and Geriatric Medicine, Department of Medicine, University of Washington School of Medicine, Seattle, WA 98195, USA
| |
Collapse
|
157
|
|
158
|
Tuka B, Szabó N, Tóth E, Kincses ZT, Párdutz Á, Szok D, Körtési T, Bagoly T, Helyes Z, Edvinsson L, Vécsei L, Tajti J. Release of PACAP-38 in episodic cluster headache patients - an exploratory study. J Headache Pain 2016; 17:69. [PMID: 27475101 PMCID: PMC4967416 DOI: 10.1186/s10194-016-0660-7] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2016] [Accepted: 07/22/2016] [Indexed: 01/01/2023] Open
Abstract
Background Activation of the trigeminal-autonomic reflex, involving the trigeminal ganglion, the superior salivatory nucleus and the sphenopalatine ganglion (SPG) is crucial in the pathophysiology of cluster headache (CH). Since pituitary adenylate cyclase-activating polypeptide-38 (PACAP-38) is present both in the SPG and the trigeminal ganglion (TG) and its role in migraine has been described, our aim was to determine the plasma PACAP-38 levels in different phases of episodic CH (ECH). Peripheral cubital fossa blood samples were taken during the ictal and inter-bout periods of male ECH patients and from age-matched healthy controls (n = 9). Plasma PACAP-38-like immunoreactivity (LI) was measured with specific and sensitive radioimmunoassay. Findings Significantly lower plasma PACAP-38-LI was detected in the inter-bout period of ECH patients than in healthy controls. However, PACAP-38 was significantly elevated in the plasma during CH attacks as compared to the inter-bout phase in the same subjects (n = 5). Conclusions This exploratory study suggests that PACAP-38 may be released during the attacks of ECH. Further patients and long-term follow-up are necessary to reveal its function.
Collapse
Affiliation(s)
- Bernadett Tuka
- Department of Neurology, Faculty of Medicine, University of Szeged, Semmelweis u. 6, Szeged, H-6725, Hungary.,MTA-SZTE Neuroscience Research Group, Semmelweis u. 6, Szeged, H-6725, Hungary
| | - Nikoletta Szabó
- Department of Neurology, Faculty of Medicine, University of Szeged, Semmelweis u. 6, Szeged, H-6725, Hungary
| | - Eszter Tóth
- Department of Neurology, Faculty of Medicine, University of Szeged, Semmelweis u. 6, Szeged, H-6725, Hungary
| | - Zsigmond Tamás Kincses
- Department of Neurology, Faculty of Medicine, University of Szeged, Semmelweis u. 6, Szeged, H-6725, Hungary
| | - Árpád Párdutz
- Department of Neurology, Faculty of Medicine, University of Szeged, Semmelweis u. 6, Szeged, H-6725, Hungary
| | - Délia Szok
- Department of Neurology, Faculty of Medicine, University of Szeged, Semmelweis u. 6, Szeged, H-6725, Hungary
| | - Tamás Körtési
- Department of Neurology, Faculty of Medicine, University of Szeged, Semmelweis u. 6, Szeged, H-6725, Hungary
| | - Teréz Bagoly
- Department of Pharmacology and Pharmacotherapy, Faculty of Medicine, University of Pécs, Szigeti u. 12, Pécs, H-7624, Hungary
| | - Zsuzsanna Helyes
- Department of Pharmacology and Pharmacotherapy, Faculty of Medicine, University of Pécs, Szigeti u. 12, Pécs, H-7624, Hungary.,János Szentágothai Research Center, University of Pécs, Ifjúság útja 20, Pécs, H-7624, Hungary.,MTA-PTE NAP B Pain Research Group, University of Pécs, Szigeti u. 12, Pécs, H-7624, Hungary
| | - Lars Edvinsson
- Department of Clinical Sciences, Division of Experimental Vascular Research, Lund University, Sölvegatan 17, BMC A13, Lund, 22184, Sweden
| | - László Vécsei
- Department of Neurology, Faculty of Medicine, University of Szeged, Semmelweis u. 6, Szeged, H-6725, Hungary.,MTA-SZTE Neuroscience Research Group, Semmelweis u. 6, Szeged, H-6725, Hungary
| | - János Tajti
- Department of Neurology, Faculty of Medicine, University of Szeged, Semmelweis u. 6, Szeged, H-6725, Hungary.
| |
Collapse
|
159
|
Abstract
Context The classification of headache disorders has improved over the years, but further work is needed to develop and improve headache diagnosis within headache subtypes. The present review is a call for action to implement laboratory tests in the classification and management of primary and some secondary headaches. Background In this narrative review we present and discuss published tests that might be useful in phenotyping and/or diagnosis of long-lasting headache disorders such as migraine, tension-type headache, trigeminal autonomic cephalalgias, trigeminal neuralgia and persisting secondary headaches. Aim The palpometer test, quantitative sensory testing, nociceptive blink reflex and autonomic tests may be valuable to phenotype and/or diagnose subforms of migraine, tension-type headache, cluster headache, trigeminal neuralgia and medication-overuse headache. Provocation tests with glyceryl trinitrate (GTN) and calcitonin gene-related peptide (CGRP) may be valuable in subclassification of migraine and cluster headache. Lumbar pressure monitoring and optical coherence tomography may valuable tools to diagnose and follow patients with chronic headache and raised intracranial pressure. Finding A number of laboratory tests in headache research are presently available, but have primarily been performed in single research studies or a few studies that differ in methods and patient groups. At present, there is no evidence-based strategy for implementing diagnostic tests, but this could be achieved if well-reputed tertiary headache centers commence developing and implementing laboratory tests in order to improve the classification and treatment of headache patients.
Collapse
Affiliation(s)
- Henrik Winther Schytz
- University of Copenhagen, Danish Headache Centre, Department of Neurology at Glostrup Hospital, Denmark
| | - Jes Olesen
- University of Copenhagen, Danish Headache Centre, Department of Neurology at Glostrup Hospital, Denmark
| |
Collapse
|
160
|
Guo S, Vollesen ALH, Hansen YBL, Frandsen E, Andersen MR, Amin FM, Fahrenkrug J, Olesen J, Ashina M. Part II: Biochemical changes after pituitary adenylate cyclase-activating polypeptide-38 infusion in migraine patients. Cephalalgia 2016; 37:136-147. [PMID: 26994298 DOI: 10.1177/0333102416639517] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background Intravenous infusion of pituitary adenylate cyclase-activating polypeptide-38 (PACAP38) provokes migraine attacks in 65-70% of migraine without aura (MO) patients. We investigated whether PACAP38 infusion causes changes in the endogenous production of PACAP38, vasoactive intestinal polypeptide (VIP), calcitonin gene-related peptide (CGRP), tumour necrosis factor alpha (TNFα), S100 calcium binding protein B (S100B), neuron-specific enolase and pituitary hormones in migraine patients. Methods We allocated 32 previously genotyped MO patients to receive intravenous infusion PACAP38 (10 pmol/kg/minute) for 20 minutes and recorded migraine-like attacks. Sixteen of the patients were carriers of the risk allele rs2274316 ( MEF2D), which confers increased risk of MO and may regulate PACAP38 expression, and 16 were non-carriers. We collected blood samples at baseline and 20, 30, 40, 60 and 90 minutes after the start of the infusion. A control group of six healthy volunteers received intravenous saline. Results PACAP38 infusion caused significant changes in plasma concentrations of VIP ( p = 0.026), prolactin ( p = 0.011), S100B ( p < 0.001) and thyroid-stimulating hormone (TSH; p = 0.015), but not CGRP ( p = 0.642) and TNFα ( p = 0.535). We found no difference in measured biochemical variables after PACAP38 infusion in patients who later developed migraine-like attacks compared to those who did not ( p > 0.05). There was no difference in the changes of biochemical variables between patients with and without the MEF2D-associated gene variant ( p > 0.05). Conclusion PACAP38 infusion elevated the plasma levels of VIP, prolactin, S100B and TSH, but not CGRP and TNFα. Development of delayed migraine-like attacks or the presence of the MEF2D gene variant was not associated with pre-ictal changes in plasma levels of neuropeptides, TNFα and pituitary hormones.
Collapse
Affiliation(s)
- Song Guo
- 1 Danish Headache Center and Department of Neurology, Rigshospitalet, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Anne Luise Haulund Vollesen
- 1 Danish Headache Center and Department of Neurology, Rigshospitalet, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Young Bae Lee Hansen
- 2 Department of Clinical Biochemistry, Rigshospitalet, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Erik Frandsen
- 3 Department of Diagnostics, Rigshospitalet, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Malene Rohr Andersen
- 4 Department of Clinical Biochemistry, Herlev and Gentofte Hospital, Gentofte, Denmark
| | - Faisal Mohammad Amin
- 1 Danish Headache Center and Department of Neurology, Rigshospitalet, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jan Fahrenkrug
- 5 Department of Clinical Biochemistry, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Jes Olesen
- 1 Danish Headache Center and Department of Neurology, Rigshospitalet, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Messoud Ashina
- 1 Danish Headache Center and Department of Neurology, Rigshospitalet, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
161
|
Guo S, Vollesen ALH, Hansen RD, Esserlind AL, Amin FM, Christensen AF, Olesen J, Ashina M. Part I: Pituitary adenylate cyclase-activating polypeptide-38 induced migraine-like attacks in patients with and without familial aggregation of migraine. Cephalalgia 2016; 37:125-135. [DOI: 10.1177/0333102416639516] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Background Intravenous infusion of adenylate cyclase-activating polypeptide-38 (PACAP38) provokes migraine-like attacks in 65–70% of migraine sufferers. Whether aggregation of migraine in first-degree relatives contributes to this discrepancy in PACAP38-induced response is unknown. We hypothesized that genetic enrichment plays a role in triggering of migraine and that migraine without aura patients with a high family load ( ≥ 2 first-degree relatives with migraine) would report more migraine-like attacks after intravenous infusion of human PACAP38. Methods In this study, we allocated 32 previously genotyped migraine without aura patients to receive intravenous infusion of 10 pmol/kg/min PACAP38 and recorded migraine-like attacks including headache characteristics and associated symptoms. Information of familial aggregation was obtained by telephone interview of first-degree relatives using a validated semi-structured questionnaire. Results PACAP38 infusion induced a migraine-like attack in 75% (nine out of 12) of patients with high family load compared to 70% (14 out of 20) with low family load ( P = 0.761). In an explorative investigation, we found that the migraine response after PACAP38 was not associated with the risk allele of rs2274316 ( MEF2D), which confers increased risk of migraine without aura and may regulate PACAP38 expression. Conclusion Migraine response to PACAP38 infusion in migraine without aura patients is not associated with high family load or the risk allele of rs2274316 ( MEF2D).
Collapse
Affiliation(s)
- Song Guo
- The Danish Headache Center and Department of Neurology, Rigshospitalet, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Anne Luise Haulund Vollesen
- The Danish Headache Center and Department of Neurology, Rigshospitalet, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Rikke Dyhr Hansen
- The Danish Headache Center and Department of Neurology, Rigshospitalet, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Ann-Louise Esserlind
- The Danish Headache Center and Department of Neurology, Rigshospitalet, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Faisal Mohammed Amin
- The Danish Headache Center and Department of Neurology, Rigshospitalet, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Anne Francke Christensen
- The Danish Headache Center and Department of Neurology, Rigshospitalet, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Jes Olesen
- The Danish Headache Center and Department of Neurology, Rigshospitalet, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Messoud Ashina
- The Danish Headache Center and Department of Neurology, Rigshospitalet, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| |
Collapse
|
162
|
Riesco N, Cernuda-Morollón E, Martínez-Camblor P, Pérez-Alvarez AI, Verano L, García-Cabo C, Serrano-Pertierra E, Pascual J. Relationship between serum levels of VIP, but not of CGRP, and cranial autonomic parasympathetic symptoms: A study in chronic migraine patients. Cephalalgia 2016; 37:823-827. [DOI: 10.1177/0333102416653232] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Background Cranial autonomic parasympathetic symptoms (CAPS) appear in at least half of migraine patients theoretically as a result of the release of peptides by the trigemino-vascular system (TVS). Cranial pain pathways become sensitised by repeated episodes of TVS activation, leading to migraine chronification. Objective The objective of this article is to correlate the presence of CAPS with serum levels of vasoactive intestinal peptides (VIP) and calcitonin gene-related peptide (CGRP). Patients and methods Patients with chronic migraine (CM) were asked about the presence – during migraine attacks – of five CAPS, which were scored from 0 to 10 by using a quantitative scale. Serum VIP and CGRP levels were determined by ELISA. Results We interviewed 87 CM patients (82 females; mean age 44.7 ± 10.6 years). Seventeen had no CAPS, while 70 reported at least one CAPS. VIP levels ranged from 20.8 to 668.2 pg/ml (mean 154.5 ± 123.2). There was a significant positive correlation between scores in the CAPS scale and VIP levels (Spearman correlation coefficient = 0.227; p = 0.035). VIP levels were significantly higher in CM patients by at least one point in the scale vs those with 0 points ( p = 0.002). Analysing symptoms individually, VIP levels were numerically higher in those patients with symptoms, though they were significantly higher only in those patients with lacrimation vs those without it ( p = 0.013). There was no significant correlation between CGRP levels and the score in the CAPS scale. Conclusions Serum VIP, but not CGRP, levels seem to reflect the rate of activation of the parasympathetic arm of the TVS in migraine.
Collapse
Affiliation(s)
- N Riesco
- Neuroscience Area, Service of Neurology, University Hospital Central de Asturias and INEUROPA, Oviedo, Asturias, Spain
| | - E Cernuda-Morollón
- Neuroscience Area, Service of Neurology, University Hospital Central de Asturias and INEUROPA, Oviedo, Asturias, Spain
| | - P Martínez-Camblor
- Biostatistic Unit, University Hospital Central de Asturias Oviedo, Asturias, Spain
- Universidad Autónoma de Chile, Santiago de Chile, Chile
| | - AI Pérez-Alvarez
- Neuroscience Area, Service of Neurology, University Hospital Central de Asturias and INEUROPA, Oviedo, Asturias, Spain
| | - L Verano
- Neuroscience Area, Service of Neurology, University Hospital Central de Asturias and INEUROPA, Oviedo, Asturias, Spain
| | - C García-Cabo
- Neuroscience Area, Service of Neurology, University Hospital Central de Asturias and INEUROPA, Oviedo, Asturias, Spain
| | - E Serrano-Pertierra
- Neuroscience Area, Service of Neurology, University Hospital Central de Asturias and INEUROPA, Oviedo, Asturias, Spain
| | - J Pascual
- Neuroscience Area, Service of Neurology, University Hospital Central de Asturias and INEUROPA, Oviedo, Asturias, Spain
- University Hospital Marqués de Valdecilla and IDIVAL, Santander, Spain
| |
Collapse
|
163
|
Vollesen ALH, Guo S, Ashina M. PACAP38 dose-response pilot study in migraine patients. Cephalalgia 2016; 37:391-395. [DOI: 10.1177/0333102416644435] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Intravenous infusion of 10 pmol/kg/min pituitary adenylate cyclase-activating polypeptide-38 (PACAP38) induces migraine-like attacks in migraine patients without aura (MO). Here, we conducted a pilot study and investigated if lower doses of PACAP38 exert similar migraine-inducing abilities. Methods We randomly allocated six MO patients to receive intravenous infusion of 4, 6, and 8 pmol/kg/min of PACAP38 over 20 minutes in a double-blind, three-way cross-over study. Headache and migraine characteristics were recorded during hospital (0–2 hours) and post-hospital (2–13 hours) phases. Results PACAP38 induced migraine-like attacks in one out of six patients with 4 pmol, two out of six patients with 6 pmol and three out of six patients with 8 pmol ( p = 0.368). All patients reported head pain after 8 pmol/kg/min, whereas five of six participants reported head pain after both 4 and 6 pmol/kg/min. We found no difference between the three doses in the AUC for headache intensity over the 12-hour observation period ( p = 0.142). An exploratory analysis showed a significant difference between 4 pmol and 8 pmol ( p = 0.031). Conclusion A trend of a dose-response relationship between dose of PACAP38 and incidence of migraine was observed. We suggest that 10 pmol/kg/min PACAP38 is the most optimal dose to induce migraine-like attacks.
Collapse
Affiliation(s)
- Anne Luise Haulund Vollesen
- Danish Headache Center and Department of Neurology, Rigshospitalet, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Song Guo
- Danish Headache Center and Department of Neurology, Rigshospitalet, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Messoud Ashina
- Danish Headache Center and Department of Neurology, Rigshospitalet, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| |
Collapse
|
164
|
Amin FM, Hougaard A, Magon S, Asghar MS, Ahmad NN, Rostrup E, Sprenger T, Ashina M. Change in brain network connectivity during PACAP38-induced migraine attacks: A resting-state functional MRI study. Neurology 2015; 86:180-7. [PMID: 26674334 DOI: 10.1212/wnl.0000000000002261] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Accepted: 09/02/2015] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE To investigate resting-state functional connectivity in the salience network (SN), the sensorimotor network (SMN), and the default mode network (DMN) during migraine attacks induced by pituitary adenylate cyclase-activating polypeptide-38 (PACAP38). METHODS In a double-blind, randomized study, 24 female migraine patients without aura received IV PACAP38 or vasoactive intestinal polypeptide (VIP) over 20 minutes. Both peptides are closely related and cause vasodilation, but only PACAP38 induces migraine attacks. VIP was therefore used as active placebo. Resting-state functional MRI was recorded before and during PACAP38-induced migraine attacks and before and after VIP infusion. We analyzed data by Statistical Parametric Mapping 8 and the Resting-State fMRI Data Analysis Toolkit for Matlab in a seed-based fashion. RESULTS PACAP38 (n = 16) induced migraine attacks and increased connectivity with the bilateral opercular part of the inferior frontal gyrus in the SN. In SMN, there was increased connectivity with the right premotor cortex and decreased connectivity with the left visual cortex. Several areas showed increased (left primary auditory, secondary somatosensory, premotor, and visual cortices) and decreased (right cerebellum and left frontal lobe) connectivity with DMN. We found no resting-state network changes after VIP (n = 15). CONCLUSIONS PACAP38-induced migraine attack is associated with altered connectivity of several large-scale functional networks of the brain.
Collapse
Affiliation(s)
- Faisal Mohammad Amin
- From the Danish Headache Center and Department of Neurology (F.M.A., A.H., M.S.A., N.N.A., M.A.) and the Functional Imaging Unit, Department of Clinical Physiology and Nuclear Medicine (E.R.), Rigshospitalet Glostrup, University of Copenhagen, Denmark; the Department of Neurology (S.M.), University Hospital Basel, Switzerland; and the Department of Neurology (T.S.), DKD Helios Klinik Wiesbaden, Germany
| | - Anders Hougaard
- From the Danish Headache Center and Department of Neurology (F.M.A., A.H., M.S.A., N.N.A., M.A.) and the Functional Imaging Unit, Department of Clinical Physiology and Nuclear Medicine (E.R.), Rigshospitalet Glostrup, University of Copenhagen, Denmark; the Department of Neurology (S.M.), University Hospital Basel, Switzerland; and the Department of Neurology (T.S.), DKD Helios Klinik Wiesbaden, Germany
| | - Stefano Magon
- From the Danish Headache Center and Department of Neurology (F.M.A., A.H., M.S.A., N.N.A., M.A.) and the Functional Imaging Unit, Department of Clinical Physiology and Nuclear Medicine (E.R.), Rigshospitalet Glostrup, University of Copenhagen, Denmark; the Department of Neurology (S.M.), University Hospital Basel, Switzerland; and the Department of Neurology (T.S.), DKD Helios Klinik Wiesbaden, Germany
| | - Mohammad Sohail Asghar
- From the Danish Headache Center and Department of Neurology (F.M.A., A.H., M.S.A., N.N.A., M.A.) and the Functional Imaging Unit, Department of Clinical Physiology and Nuclear Medicine (E.R.), Rigshospitalet Glostrup, University of Copenhagen, Denmark; the Department of Neurology (S.M.), University Hospital Basel, Switzerland; and the Department of Neurology (T.S.), DKD Helios Klinik Wiesbaden, Germany
| | - Nur Nabil Ahmad
- From the Danish Headache Center and Department of Neurology (F.M.A., A.H., M.S.A., N.N.A., M.A.) and the Functional Imaging Unit, Department of Clinical Physiology and Nuclear Medicine (E.R.), Rigshospitalet Glostrup, University of Copenhagen, Denmark; the Department of Neurology (S.M.), University Hospital Basel, Switzerland; and the Department of Neurology (T.S.), DKD Helios Klinik Wiesbaden, Germany
| | - Egill Rostrup
- From the Danish Headache Center and Department of Neurology (F.M.A., A.H., M.S.A., N.N.A., M.A.) and the Functional Imaging Unit, Department of Clinical Physiology and Nuclear Medicine (E.R.), Rigshospitalet Glostrup, University of Copenhagen, Denmark; the Department of Neurology (S.M.), University Hospital Basel, Switzerland; and the Department of Neurology (T.S.), DKD Helios Klinik Wiesbaden, Germany
| | - Till Sprenger
- From the Danish Headache Center and Department of Neurology (F.M.A., A.H., M.S.A., N.N.A., M.A.) and the Functional Imaging Unit, Department of Clinical Physiology and Nuclear Medicine (E.R.), Rigshospitalet Glostrup, University of Copenhagen, Denmark; the Department of Neurology (S.M.), University Hospital Basel, Switzerland; and the Department of Neurology (T.S.), DKD Helios Klinik Wiesbaden, Germany
| | - Messoud Ashina
- From the Danish Headache Center and Department of Neurology (F.M.A., A.H., M.S.A., N.N.A., M.A.) and the Functional Imaging Unit, Department of Clinical Physiology and Nuclear Medicine (E.R.), Rigshospitalet Glostrup, University of Copenhagen, Denmark; the Department of Neurology (S.M.), University Hospital Basel, Switzerland; and the Department of Neurology (T.S.), DKD Helios Klinik Wiesbaden, Germany.
| |
Collapse
|
165
|
Akerman S, Goadsby PJ. Neuronal PAC1receptors mediate delayed activation and sensitization of trigeminocervical neurons: Relevance to migraine. Sci Transl Med 2015; 7:308ra157. [DOI: 10.1126/scitranslmed.aaa7557] [Citation(s) in RCA: 88] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
|
166
|
Han X, Dong Z, Hou L, Wan D, Chen M, Tang W, Yu S. Interictal plasma pituitary adenylate cyclase-activating polypeptide levels are decreased in migraineurs but remain unchanged in patients with tension-type headache. Clin Chim Acta 2015; 450:151-4. [PMID: 26296898 DOI: 10.1016/j.cca.2015.08.017] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Revised: 07/29/2015] [Accepted: 08/17/2015] [Indexed: 01/21/2023]
Abstract
BACKGROUND Pituitary adenylate cyclase-activating polypeptide (PACAP) is associated with migraine phase; however, whether PACAP levels could be used to distinguish between migraine and tension-type headache (TTH) remains unknown. We compared interictal plasma PACAP levels among healthy controls, migraineurs, and patients with TTH. METHODS Interictal plasma levels of PACAP were measured in 133 migraineurs, 106 patients with TTH, and 50 controls using enzyme-linked immunoassays. We further evaluated the relationships between interictal PACAP plasma concentrations and clinical parameters, such as headache severity, attack frequency, and duration. RESULTS We found that migraineurs had significantly lower interictal plasma PACAP levels than patients with TTH and healthy controls. However, there were no significant differences between patients with TTH and healthy controls. Plasma PACAP levels were significantly lower in patients with episodic migraine (EM) than in patients with episodic tension-type headache (ETTH) and in patients with chronic migraine (CM) than in patients with chronic tension-type headache (CTTH). Interictal PACAP levels were negatively correlated with duration in the CM group. CONCLUSIONS The results of this study demonstrated differences in interictal PACAP levels in migraine and TTH, suggesting that PACAP is involved in the pathogenesis of migraine rather than TTH.
Collapse
Affiliation(s)
- Xun Han
- Medical Center, Tsinghua University, Beijing 100084, China; Department of Neurology, Chinese PLA General Hospital, Beijing 100853, China
| | - Zhao Dong
- Department of Neurology, Chinese PLA General Hospital, Beijing 100853, China
| | - Lei Hou
- Department of Neurology, Chinese PLA General Hospital, Beijing 100853, China
| | - Dongjun Wan
- Department of Neurology, Chinese PLA General Hospital, Beijing 100853, China
| | - Min Chen
- Department of Neurology, Chinese PLA General Hospital, Beijing 100853, China
| | - Wenjing Tang
- Department of Neurology, Chinese PLA General Hospital, Beijing 100853, China
| | - Shengyuan Yu
- Department of Neurology, Chinese PLA General Hospital, Beijing 100853, China.
| |
Collapse
|
167
|
Tajti J, Szok D, Majláth Z, Tuka B, Csáti A, Vécsei L. Migraine and neuropeptides. Neuropeptides 2015; 52:19-30. [PMID: 26094101 DOI: 10.1016/j.npep.2015.03.006] [Citation(s) in RCA: 87] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Revised: 03/22/2015] [Accepted: 03/25/2015] [Indexed: 12/25/2022]
Abstract
Migraine is a common disabling neurovascular primary headache disorder. The pathomechanism is not clear, but extensive preclinical and clinical studies are ongoing. The structural basis of the leading hypothesis is the trigeminovascular system, which includes the trigeminal ganglion, the meningeal vasculature, and the distinct nuclei of the brainstem, the thalamus and the somatosensory cortex. This review covers the effects of sensory (calcitonin gene-related peptide, pituitary adenylate cyclase-activating polypeptide and substance P), sympathetic (neuropeptide Y) and parasympathetic (vasoactive intestinal peptide) migraine-related neuropeptides and the functions of somatostatin, nociceptin and the orexins in the trigeminovascular system. These neuropeptides may take part in neurogenic inflammation (plasma protein extravasation and vasodilatation) of the intracranial vasculature and peripheral and central sensitization of the trigeminal system. The results of human clinical studies are discussed with regard to the alterations in these neuropeptides in the plasma, saliva and cerebrospinal fluid during or between migraine attacks, and the therapeutic possibilities involving migraine-related neuropeptides in the acute and prophylactic treatment of migraine headache are surveyed.
Collapse
Affiliation(s)
- János Tajti
- Department of Neurology, University of Szeged, Semmelweis u. 6, Szeged H-6725, Hungary.
| | - Délia Szok
- Department of Neurology, University of Szeged, Semmelweis u. 6, Szeged H-6725, Hungary
| | - Zsófia Majláth
- Department of Neurology, University of Szeged, Semmelweis u. 6, Szeged H-6725, Hungary
| | - Bernadett Tuka
- MTA - SZTE Neuroscience Research Group, Semmelweis u. 6, Szeged H-6725, Hungary
| | - Anett Csáti
- MTA - SZTE Neuroscience Research Group, Semmelweis u. 6, Szeged H-6725, Hungary
| | - László Vécsei
- Department of Neurology, University of Szeged, Semmelweis u. 6, Szeged H-6725, Hungary; MTA - SZTE Neuroscience Research Group, Semmelweis u. 6, Szeged H-6725, Hungary
| |
Collapse
|
168
|
Meredith ME, Salameh TS, Banks WA. Intranasal Delivery of Proteins and Peptides in the Treatment of Neurodegenerative Diseases. AAPS JOURNAL 2015; 17:780-7. [PMID: 25801717 DOI: 10.1208/s12248-015-9719-7] [Citation(s) in RCA: 114] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Accepted: 01/12/2015] [Indexed: 12/28/2022]
Abstract
The blood-brain barrier (BBB) is a major impediment to the therapeutic delivery of peptides and proteins to the brain. Intranasal delivery often provides a non-invasive means to bypass the BBB. Advantages of using intranasal delivery include minimizing exposure to peripheral organs and tissues, thus reducing systemic side effects. It also allows substances that typically have rapid degradation in the blood time to exert their effect. Intranasal delivery provides the ability to target proteins and peptides to specific regions of the brain when administered with substrates like cyclodextrins. In this review, we examined the use of intranasal delivery of various proteins and peptides that have implications in the treatment of neurodegenerative diseases, focusing especially on albumin, exendin/GLP-1, GALP, insulin, leptin, and PACAP. We have described their rationale for use, distribution in the brain after intranasal injection, how intranasal administration differed from other modes of delivery, and their use in clinical trials, if applicable. Intranasal delivery of drugs, peptides, and other proteins could be very useful in the future for the prevention or treatment of brain related diseases.
Collapse
|
169
|
Affiliation(s)
- Laura H Schulte
- Department of Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Hamburg D-22046, Germany
| | - Arne May
- Department of Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Hamburg D-22046, Germany.
| |
Collapse
|
170
|
Tajti J, Csáti A, Vécsei L. Novel strategies for the treatment of migraine attacks via the CGRP, serotonin, dopamine, PAC1, and NMDA receptors. Expert Opin Drug Metab Toxicol 2014; 10:1509-20. [PMID: 25253587 DOI: 10.1517/17425255.2014.963554] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Migraine is a common, paroxysmal, and disabling primary headache with a high personal and socioeconomic impact. It involves ∼ 16% of the general population. During the years, a number of hypotheses have been put forward concerning the exact pathomechanism, but the final solution is still undiscovered. AREAS COVERED Although the origin is enigmatic, parallel therapeutic efforts have been developed. Current attack therapy does not meet the expectations of the patients or the doctors. This article, based on a PubMed search, reviews the novel pharmacological possibilities that influence the peripheral and central sensitization involved in the disease. EXPERT OPINION In order to overcome the therapeutic insufficiency, a calcitonin gene-related peptide receptor antagonist without the side-effect of liver transaminase elevation is required. Another therapeutic option is to develop a neurally acting antimigraine agent, such as a serotonin-1F receptor agonist, with low adverse central nervous system events. Development of a potent dopamine receptor antagonist is necessary to diminish the premonitory symptoms of migraine. A further option is to decrease the headache intensity with a pituitary adenylate cyclase-activating polypeptide type 1 receptor blocker which can cross the blood-brain barrier. Finally, synthetic kynurenine analogues are required to block the pain transmission in the activated trigeminal system.
Collapse
Affiliation(s)
- János Tajti
- University of Szeged, Department of Neurology , Semmelweis u. 6, H-6725, Szeged , Hungary
| | | | | |
Collapse
|
171
|
|
172
|
Affiliation(s)
- László Vécsei
- Department of Neurology, University of Szeged, Szeged, Hungary
| | | | | |
Collapse
|
173
|
Edvinsson L. PACAP and its receptors in migraine pathophysiology: Commentary on Walker et al., Br J Pharmacol 171: 1521-1533. Br J Pharmacol 2014; 172:4782-4. [PMID: 24826981 DOI: 10.1111/bph.12772] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2014] [Revised: 04/25/2014] [Accepted: 04/30/2014] [Indexed: 11/28/2022] Open
Affiliation(s)
- Lars Edvinsson
- Department of Medicine, Institute of Clinical Sciences, Lund University, Sweden
| |
Collapse
|
174
|
Amin FM, Lundholm E, Hougaard A, Arngrim N, Wiinberg L, de Koning PJ, Larsson HB, Ashina M. Measurement precision and biological variation of cranial arteries using automated analysis of 3 T magnetic resonance angiography. J Headache Pain 2014; 15:25. [PMID: 24886137 PMCID: PMC4229959 DOI: 10.1186/1129-2377-15-25] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2014] [Accepted: 04/25/2014] [Indexed: 11/24/2022] Open
Abstract
Background Non-invasive magnetic resonance angiography (MRA) has facilitated repeated measurements of human cranial arteries in several headache and migraine studies. To ensure comparability across studies the same automated analysis software has been used, but the intra- and interobserver, day-to-day and side-to-side variations have not yet been published. We hypothesised that the observer related, side-to-side, and day-to-day variations would be less than 10%. Methods Ten female participants were studied using high-resolution MRA on two study days separated by at least one week. Using the automated LKEB-MRA vessel wall analysis software arterial circumferences were measured by blinded observers. Each artery was analysed twice by each of the two different observers. The primary endpoints were to determine the intraclass correlation coefficient (ICC) and intra- an inter-observer, the day-to-day, and side-to-side variations of the circumference of the middle meningeal (MMA) and middle cerebral (MCA) arteries. Results We found an excellent intra- and interobserver agreement for the MMA (ICC: 0.909-0.987) and for the MCA (ICC: 0.876-0.949). The coefficient of variance within observers was ≤1.8% for MMA and ≤3.1% for MCA; between observers ≤3.4% (MMA) and ≤4.1% (MCA); between days ≤6.0% (MMA) and ≤8.0% (MCA); between sides ≤9.4% (MMA) and ≤6.5% (MCA). Conclusion The present study demonstrates a low (<5%) inter- and intraobserver variation using the automated LKEB-MRA vessel wall analysis software. Furthermore, the study also suggests that the day-to-day and side-to-side variations of the MMA and MCA circumferences are less than 10%.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | - Messoud Ashina
- Danish Headache Center and Department of Neurology, Glostrup Hospital, Faculty of Health and Medical Sciences, University of Copenhagen, Nordre Ringvej 57, DK-2600 Glostrup, Denmark.
| |
Collapse
|
175
|
Millichap JG, Millichap JJ. Role of PACAP in Migraine Headaches. Pediatr Neurol Briefs 2014. [DOI: 10.15844/pedneurbriefs-28-4-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
|