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Sun S, Zheng G, Zhou D, Zhu L, He X, Zhang C, Wang C, Yuan C. Emodin Interferes With Nitroglycerin-Induced Migraine in Rats Through CGMP-PKG Pathway. Front Pharmacol 2021; 12:758026. [PMID: 34744735 PMCID: PMC8563583 DOI: 10.3389/fphar.2021.758026] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 10/05/2021] [Indexed: 02/03/2023] Open
Abstract
The purpose of this research was to explore the effect and mechanism of emodin in interfering with nitroglycerin-induced migraine rats. We carried out behavioral research within 2 h post-nitroglycerin (NTG) injection, and blood samples were collected through the abdominal aorta for measurements of nitric oxide (NO), calcitonin gene-related peptide (CGRP), substance P (SP), tumor necrosis factor (TNF-α) and cyclic guanosine monophosphate (cGMP) levels. Immunohistochemistry was adopted to detect the activation of c-Fos immunoreactive neurons in brain tissues. The number and integrated optical density (IOD) of c-Fos positive cells were measured using Image-Pro Plus. Western blotting was applied to detect the levels of PKG protein in rat brain tissues. The results showed that emodin can alleviate the pain response of migraine rats and significantly reduce the levels of NO, CGRP, SP, TNF-α and cGMP in migraine rats. In addition, emodin can significantly reduce the number of c-Fos positive cells and the IOD value. Moreover, the expression of PKG protein was significantly inhibited by emodin. Therefore, it is inferred that emodin can relieve migraine induced by NTG through the cGMP-PKG pathway, and can be used as a potential botanical medicine for the treatment of migraine.
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Affiliation(s)
- Shuding Sun
- School of Traditional Chinese Pharmacy, China Pharmaceutical University, Nanjing, China
| | - Guo Zheng
- School of Traditional Chinese Pharmacy, China Pharmaceutical University, Nanjing, China
| | - Decui Zhou
- School of Traditional Chinese Pharmacy, China Pharmaceutical University, Nanjing, China
| | - Lili Zhu
- School of Traditional Chinese Pharmacy, China Pharmaceutical University, Nanjing, China
| | - Xin He
- School of Biomedical Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong, SAR China
| | - Chunfeng Zhang
- School of Traditional Chinese Pharmacy, China Pharmaceutical University, Nanjing, China
| | - Chongzhi Wang
- Tang Center of Herbal Medicine Research and Department of Anesthesia and Critical Care, University of Chicago, Chicago, IL, United States
| | - Chunsu Yuan
- Tang Center of Herbal Medicine Research and Department of Anesthesia and Critical Care, University of Chicago, Chicago, IL, United States
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Onderwater GLJ, Wijnen JP, Najac C, van Dongen RM, Ronen I, Webb A, Zielman R, van Zwet EW, Ferrari MD, Kan HE, Kruit MC, Terwindt GM. Cortical glutamate and gamma-aminobutyric acid over the course of a provoked migraine attack, a 7 Tesla magnetic resonance spectroscopy study. NEUROIMAGE: CLINICAL 2021; 32:102889. [PMID: 34911195 PMCID: PMC8640106 DOI: 10.1016/j.nicl.2021.102889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 11/03/2021] [Accepted: 11/16/2021] [Indexed: 11/16/2022] Open
Abstract
7T MRS separately measured glutamate, glutamine and GABA towards triggered attacks. Visual cortex GABA levels increased towards a preictal migraine state. Visual cortex glutamate and glutamine levels were stable across migraine states.
Enhanced activity of the glutamatergic system has been linked to migraine pathophysiology. The present study aimed to assess the involvement of the glutamatergic system in the onset of attacks. We provoked attacks by infusion of glyceryl trinitrate (GTN; 0.5 µg/kg/min over 20 min) in 24 female episodic migraineurs without aura and 13 female age-matched healthy controls. Over the course of a single day participants were scanned three times at fixed time slots (baseline before GTN infusion, 90 min and 270 min after start of GTN infusion). Single-volume proton magnetic resonance spectra (1H–MRS) were acquired at 7 Tesla from a volume of interest (VOI, 2x2x3 cm) in the visual cortex. We assessed the concentrations of glutamate, its major precursor glutamine, and its product gamma-aminobutyric acid (GABA) over the course of a provoked attack. The preictal state was defined as the period after GTN infusion until the migraine-like headache started, independent of possible experienced premonitory symptoms, and the ictal state was defined as the period with provoked migraine-like headache. Data were analyzed using a linear mixed-effect model for repeated measures. Glutamate and glutamine levels did not change from interictal to the preictal and ictal state. GABA levels increased from interictal towards the preictal state for migraine patients compared with healthy controls. We conclude that high resolution 7T MRS is able to show changes in the glutamatergic system towards a triggered migraine attack, by revealing an increased GABA concentration associated with the onset of a migraine attack.
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Affiliation(s)
| | - Jannie P Wijnen
- Department of Radiology, C.J. Gorter Center for High Field MRI, Leiden University Medical Center, Leiden, The Netherlands; Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Chloé Najac
- Department of Radiology, C.J. Gorter Center for High Field MRI, Leiden University Medical Center, Leiden, The Netherlands
| | - Robin M van Dongen
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | - Itamar Ronen
- Department of Radiology, C.J. Gorter Center for High Field MRI, Leiden University Medical Center, Leiden, The Netherlands
| | - Andrew Webb
- Department of Radiology, C.J. Gorter Center for High Field MRI, Leiden University Medical Center, Leiden, The Netherlands
| | - Ronald Zielman
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | - Erik W van Zwet
- Department of Medical Statistics and Bioinformatics, Leiden University Medical Center, Leiden, The Netherlands
| | - Michel D Ferrari
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | - Hermien E Kan
- Department of Radiology, C.J. Gorter Center for High Field MRI, Leiden University Medical Center, Leiden, The Netherlands
| | - Mark C Kruit
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Gisela M Terwindt
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands.
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Abstract
Primary headaches are one of the most prevalent neurological disorders and can occur during a wide range of lifespan. Primary headaches, especially migraine, are cyclic disorders with a complex sequence of symptoms within every headache attack. There is no systematic review of whether these symptoms changes during lifespan. Indeed, the clinical presentation of migraine shows an age-dependent change with a significantly shorter duration of the attacks and occurrence of different paroxysmal symptoms, such as vomiting, abdominal pain or vertigo, in childhood and, in contrast, largely an absence of autonomic signs and a more often bilateral headache in the elderly. The age-dependent differences in the clinical presentation are less distinct in cluster headache and, especially, in tension-type headache. The differences in the clinical presentation are in agreement with the idea that the connectivity of hypothalamic areas with different brainstem areas, especially the central parasympathetic areas, is important for the clinical manifestation of migraine, as well as, the change during lifespan.
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Affiliation(s)
- Andreas Straube
- Department of Neurology, University Hospital LMU, Ludwig-Maximilians-University, 81377, Munich, Germany.
| | - Anna Andreou
- Headache Research, Wolfson CARD, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.,The Headache Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK
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Artero-Morales M, González-Rodríguez S, Ferrer-Montiel A. TRP Channels as Potential Targets for Sex-Related Differences in Migraine Pain. Front Mol Biosci 2018; 5:73. [PMID: 30155469 PMCID: PMC6102492 DOI: 10.3389/fmolb.2018.00073] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 07/10/2018] [Indexed: 12/31/2022] Open
Abstract
Chronic pain is one of the most debilitating human diseases and represents a social and economic burden for our society. Great efforts are being made to understand the molecular and cellular mechanisms underlying the pathophysiology of pain transduction. It is particularly noteworthy that some types of chronic pain, such as migraine, display a remarkable sex dimorphism, being up to three times more prevalent in women than in men. This gender prevalence in migraine appears to be related to sex differences arising from both gonadal and genetic factors. Indeed, the functionality of the somatosensory, immune, and endothelial systems seems modulated by sex hormones, as well as by X-linked genes differentially expressed during development. Here, we review the current data on the modulation of the somatosensory system functionality by gonadal hormones. Although this is still an area that requires intense investigation, there is evidence suggesting a direct regulation of nociceptor activity by sex hormones at the transcriptional, translational, and functional levels. Data are being accumulated on the effect of sex hormones on TRP channels such as TRPV1 that make pivotal contributions to nociceptor excitability and sensitization in migraine and other chronic pain syndromes. These data suggest that modulation of TRP channels' expression and/or activity by gonadal hormones provide novel pathways for drug intervention that may be useful for targeting the sex dimorphism observed in migraine.
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Affiliation(s)
- Maite Artero-Morales
- Instituto de Biología Molecular y Celular, Universitas Miguel Hernández, Elche, Spain
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Filiz A, Tepe N, Eftekhari S, Boran HE, Dilekoz E, Edvinsson L, Bolay H. CGRP receptor antagonist MK-8825 attenuates cortical spreading depression induced pain behavior. Cephalalgia 2017; 39:354-365. [PMID: 28971699 DOI: 10.1177/0333102417735845] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND AND OBJECTIVE The present study aimed to investigate the effects of selective calcitonin gene related peptide (CGRP) receptor antagonist (MK-8825) on cortical spreading depression (CSD) induced pain behavior and anxiety in freely-moving rats, and neuronal activation in the correlated anatomical regions. METHODS CSD was induced while keeping all meningeal layers and BBB intact and MK-8825 was administered in two different doses. Regional cerebral blood flow (rCBF), arterial pressure and DC shift were recorded. Behavioral studies were conducted in freely-moving rats. Spontaneous behavior, mechanical allodynia, ultrasonic vocalization, and anxiety were evaluated. Immunohistochemistry of c-fos, CGRP, calcitonin receptor like-receptor (CLR) and receptor activity modifying protein 1 (RAMP1) were studied. RESULTS MK-8825 did not block DC shifts in the cerebral cortex and accompanied hemodynamic response. CSD significantly induced freezing and grooming behavior in freely-moving rats. MK-8825 reversed increased episodes of freezing, grooming, wet dog shake and head shake behavior. MK-8825 increased CSD-induced reductions in von Frey thresholds, but did not change elevated plus maze results. MK-8825 blocked c-fos induction by CSD in the brainstem trigeminal nucleus caudalis (TNC) and reticular nucleus of thalamus (TRN) but not in the amygdala. Immunofluorescence analysis showed no co-localization of CGRP, CLR or RAMP1 with c-fos positive cells. CONCLUSION CGRP receptor antagonist MK-8825 dose dependently attenuated CSD-induced trigeminal nerve mediated pain response without altering CSD waves and accompanied rCBF response. While blocking TNC activation, MK-8825 did not exert any effect on amygdala and anxiety behavior. CGRP receptor antagonists may also modulate thalamo-cortical gating.
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Affiliation(s)
- Aslı Filiz
- 1 Department of Neurology and Algology, Gazi University Medical School, Besevler, Ankara, Turkey
| | - Nermin Tepe
- 1 Department of Neurology and Algology, Gazi University Medical School, Besevler, Ankara, Turkey.,2 Neuropsychiatry Centre, Gazi University, Besevler, Ankara, Turkey
| | - Sajedeh Eftekhari
- 3 Lund University, Department of Medicine, Institute of Clinical Sciences, Lund, Sweden
| | - H Evren Boran
- 1 Department of Neurology and Algology, Gazi University Medical School, Besevler, Ankara, Turkey.,2 Neuropsychiatry Centre, Gazi University, Besevler, Ankara, Turkey
| | - Ergin Dilekoz
- 4 Department of Pharmacology, Gazi University Faculty of Medicine, Besevler, Ankara, Turkey
| | - Lars Edvinsson
- 3 Lund University, Department of Medicine, Institute of Clinical Sciences, Lund, Sweden
| | - Hayrunnisa Bolay
- 1 Department of Neurology and Algology, Gazi University Medical School, Besevler, Ankara, Turkey.,2 Neuropsychiatry Centre, Gazi University, Besevler, Ankara, Turkey
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6
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Zielman R, Wijnen JP, Webb A, Onderwater GLJ, Ronen I, Ferrari MD, Kan HE, Terwindt GM, Kruit MC. Cortical glutamate in migraine. Brain 2017. [DOI: 10.1093/brain/awx130] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
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Juan Y, Shu O, Jinhe L, Na Y, Yushuang D, Weiwei D, Lanying H, Jian W. Migraine prevention with percutaneous mastoid electrical stimulator: A randomized double-blind controlled trial. Cephalalgia 2016; 37:1248-1256. [PMID: 27821639 DOI: 10.1177/0333102416678623] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective To evaluate the effectiveness and safety of episodic migraine prevention with the percutaneous mastoid electrical stimulator (PMES). Methods This was a randomized, double-blind, and sham-controlled trial that involved four medical centers. Episodic patients with at least two migraine attacks every month were randomly 1:1 to PMES or sham stimulation treatment. The treatments were performed daily for 45 minutes over 3 months. The primary outcomes were change in migraine days per month and the 50% response rate. Results The PMES group had a significantly greater reduction of migraine days in the third month than the sham group (-71.3% vs. -14.4%, p < 0.001). The 50% response rate of migraine days in the PMES group (≥50% reduction of migraine days compared with the baseline) was significantly higher than that in the sham group (82.5% vs. 17.5%, p < 0.001). In the PMES group, 60% of the patients had a ≥75% reduction of migraine days in the third month, and 35% of the patients had no migraine attack in the third month. No patients in the sham group had a ≥75% reduction of migraine days. There were no adverse events in either group. Conclusion Treatment of migraine using non-invasive PMES was safe and effective.
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Affiliation(s)
- Yang Juan
- 1 Department of Neurology, The Second People's Hospital of Chengdu, Chengdu, China
| | - Ou Shu
- 2 Department of Neurology, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Lou Jinhe
- 3 Department of Neurology, The First Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Yang Na
- 4 Department of Neurology, Chongqing Emergency Medical Center, Chongqing, China
| | - Deng Yushuang
- 1 Department of Neurology, The Second People's Hospital of Chengdu, Chengdu, China
| | - Dong Weiwei
- 3 Department of Neurology, The First Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - He Lanying
- 1 Department of Neurology, The Second People's Hospital of Chengdu, Chengdu, China
| | - Wang Jian
- 1 Department of Neurology, The Second People's Hospital of Chengdu, Chengdu, China
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Vuralli D, Boran HE, Cengiz B, Coskun O, Bolay H. Somatosensory temporal discrimination remains intact in tension-type headache whereas it is disrupted in migraine attacks. Cephalalgia 2016; 37:1241-1247. [DOI: 10.1177/0333102416677050] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background and objective Somatosensory temporal discrimination was recently reported as prolonged during migraine attacks, which is consistent with disrupted sensorial perception in migraine. However, knowledge about central sensory processing in tension-type headache is still lacking. This prospective, controlled study aimed to investigate somatosensory temporal discrimination thresholds in tension-type headache. Methods The study included 10 tension-type headache patients, 10 migraine patients and 10 healthy volunteers without headache. Somatosensory temporal discrimination thresholds were evaluated during the headache attacks of tension-type headache and migraine patients. Results Somatosensory temporal discrimination thresholds of tension-type headache patients (39.0 ± 5.5 ms for the right hand and 40.6 ± 4.6 ms for the left hand) were significantly lower than those of episodic migraine patients (137.1 ± 35.8 ms for the right hand and 118.4 ± 34.3 ms for the left hand, p < 0.0001 and p < 0.0001 respectively), and comparable to those of healthy volunteers (38.6 ± 5.3 ms for the right hand and 38.3 ± 7.2 ms for the left hand, p = 0.79 and p = 0.45 respectively). Conclusion Central sensory processing, as tested by somatosensory temporal discrimination, was remarkably disrupted during the headache attacks in migraineurs, whereas it remained intact in the tension-type headache patients.
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Affiliation(s)
- Doga Vuralli
- Gazi University Faculty of Medicine, Department of Neurology and Algology, Besevler, 06510, Ankara, Turkey
- Neuropsychiatry Centre, Gazi University, Besevler, 06510, Ankara, Turkey
| | - H Evren Boran
- Gazi University Faculty of Medicine, Department of Neurology and Algology, Besevler, 06510, Ankara, Turkey
- Neuropsychiatry Centre, Gazi University, Besevler, 06510, Ankara, Turkey
| | - Bulent Cengiz
- Gazi University Faculty of Medicine, Department of Neurology, Motor Control Laboratory, Besevler, 06510, Ankara, Turkey
| | - Ozlem Coskun
- Gazi University Faculty of Medicine, Department of Neurology and Algology, Besevler, 06510, Ankara, Turkey
| | - Hayrunnisa Bolay
- Gazi University Faculty of Medicine, Department of Neurology and Algology, Besevler, 06510, Ankara, Turkey
- Neuropsychiatry Centre, Gazi University, Besevler, 06510, Ankara, Turkey
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Vuralli D, Evren Boran H, Cengiz B, Coskun O, Bolay H. Chronic Migraine Is Associated With Sustained Elevation of Somatosensory Temporal Discrimination Thresholds. Headache 2016; 56:1439-1447. [DOI: 10.1111/head.12947] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Revised: 05/20/2016] [Accepted: 06/27/2016] [Indexed: 01/21/2023]
Affiliation(s)
- Doga Vuralli
- Department of Neurology and Algology; Gazi University Faculty of Medicine; Besevler Ankara 06510 Turkey
- Neuropsychiatry Center, Gazi University Faculty of Medicine; Besevler 06510 Ankara Turkey
| | - H. Evren Boran
- Department of Neurology and Algology; Gazi University Faculty of Medicine; Besevler Ankara 06510 Turkey
- Neuropsychiatry Center, Gazi University Faculty of Medicine; Besevler 06510 Ankara Turkey
| | - Bulent Cengiz
- Department of Neurology, Motor Control Laboratory; Gazi University Faculty of Medicine; Besevler Ankara 06510 Turkey
| | - Ozlem Coskun
- Department of Neurology and Algology; Gazi University Faculty of Medicine; Besevler Ankara 06510 Turkey
| | - Hayrunnisa Bolay
- Department of Neurology and Algology; Gazi University Faculty of Medicine; Besevler Ankara 06510 Turkey
- Neuropsychiatry Center, Gazi University Faculty of Medicine; Besevler 06510 Ankara Turkey
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Abstract
During gestation, cells of the brain and gut develop almost simultaneously into the central nervous system (CNS) and enteric nervous system (ENS), respectively. They remain connected via the vagal nerve lifelong. While it is well known that the brain sends signal to the gut, communication is in fact bidirectional. Just as the brain can modulate gut functioning, the gut, and likely what we ingest, can in fact influence our brain functioning. We will first review both gastrointestinal (GI) function and migraine pathophysiology and then discuss evidence linking the migraine brain to various GI disorders. Lastly, we discuss the effects of gut microbiota on brain functioning and speculate how the gut and particularly diet may affect migraine.
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Emicrania. Neurologia 2016. [DOI: 10.1016/s1634-7072(15)76142-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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12
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Boran HE, Cengiz B, Bolay H. Somatosensory temporal discrimination is prolonged during migraine attacks. Headache 2015; 56:104-12. [DOI: 10.1111/head.12734] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/04/2015] [Indexed: 12/12/2022]
Affiliation(s)
- H. Evren Boran
- Department of Neurology; Gazi University Faculty of Medicine; Besevler 06510 Ankara Turkey
- Motor Control Laboratory, Department of Neurology; Gazi University Faculty of Medicine; Besevler 06510 Ankara Turkey
| | - Bülent Cengiz
- Department of Neurology; Gazi University Faculty of Medicine; Besevler 06510 Ankara Turkey
- Motor Control Laboratory, Department of Neurology; Gazi University Faculty of Medicine; Besevler 06510 Ankara Turkey
| | - Hayrunnisa Bolay
- Department of Neurology; Gazi University Faculty of Medicine; Besevler 06510 Ankara Turkey
- Neuropsychiatry Centre, Gazi University; Besevler 06510 Ankara Turkey
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The role of purinergic signaling in the etiology of migraine and novel antimigraine treatment. Purinergic Signal 2015; 11:307-16. [PMID: 25957584 PMCID: PMC4529850 DOI: 10.1007/s11302-015-9453-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Accepted: 04/28/2015] [Indexed: 12/23/2022] Open
Abstract
Etiopathogenesis of migraine involves different structures of the central nervous system: the trigeminal nerve with nuclei located in the brain stem, vascular system, and the cerebral cortex as well as diverse mechanisms and pathological processes. The multidirectional action of purines in different cell types (blood vessels, neurons, and satellite glial cells) and through different types of purinergic receptors contributes to the etiopathogenesis of migraine pain. Adenosine triphosphate (ATP) and its derivatives are involved in initiation and propagation of migrenogenic signals in several ways: they participate in vasomotor mechanism, cortical spreading depression, and in fast transmission or cross-excitation based on the satellite glial cells in trigeminal ganglion. Contribution of purinergic signaling in the conduction of pain is realized through the activation of P1 and P2 receptors expressed widely in the central nervous system: on the neurons and glial cells as well as on the smooth muscles and endothelium in the vascular system. Therefore, the purinergic receptors can be an excellent target for pharmacologists constructing new antimigraine therapeutics. Moreover, the mechanisms facilitating ATP and adenosine degradation may prevent vasodilatation and thus avoid a secondary central sensitization during a migraine attack. Thus, agonists and antagonists of P receptors as well as ecto-enzymes metabolizing nucleotides/nucleosides could gain the growing attention as therapeutic agents.
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Transcranial Magnetic Stimulation Reveals Cortical Hyperexcitability in Episodic Cluster Headache. THE JOURNAL OF PAIN 2015; 16:53-9. [DOI: 10.1016/j.jpain.2014.10.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2014] [Revised: 10/06/2014] [Accepted: 10/21/2014] [Indexed: 01/03/2023]
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15
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Cosentino G, Fierro B, Brighina F. From different neurophysiological methods to conflicting pathophysiological views in migraine: A critical review of literature. Clin Neurophysiol 2014; 125:1721-30. [DOI: 10.1016/j.clinph.2014.05.005] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2014] [Revised: 04/17/2014] [Accepted: 05/05/2014] [Indexed: 01/15/2023]
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16
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Cosentino G, Fierro B, Vigneri S, Talamanca S, Paladino P, Baschi R, Indovino S, Maccora S, Valentino F, Fileccia E, Giglia G, Brighina F. Cyclical changes of cortical excitability and metaplasticity in migraine: Evidence from a repetitive transcranial magnetic stimulation study. Pain 2014; 155:1070-1078. [DOI: 10.1016/j.pain.2014.02.024] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Revised: 01/20/2014] [Accepted: 02/05/2014] [Indexed: 10/25/2022]
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Abstract
BACKGROUND Histamine has been studied in both health and disease since the initial description a century ago. With its vasodilative effect, it was suggested early on to be involved in the pathophysiology of migraine. Over the past 25 years, much has been learned about histamine as a neurotransmitter in the central nervous system. The role of this neurotransmitter system in migraine has not been previously reviewed. OBJECTIVE Discuss a potential role of the brain histaminergic system in migraine. METHODS Unstructured literature search with a no specific hypothesis-driven approach. RESULTS There is substantial evidence that systemically given histamine may elicit, maintain, and aggravate headache. The mechanisms for this are not known, and histamines do not penetrate the blood-brain barrier (BBB). However, circulating histamine may influence hypothalamic activity via the circumventricular organs that lack BBB. In the rat, prolonged activation of meningeal nociceptors induced by dural mast cell degranulation has been observed. Subcutaneous injections of N-alpha-methyl histamine, a catabolite of histamine with high affinity to the histamine H3 receptor, probably have some migraine preventive effect. A negative feedback on histamine release from mast cells in proximity to C-fiber endings has been a postulated mechanism. Most antihistamines have shown to be ineffective as acute medication for migraine. Two centrally acting potent H1 receptor antagonists (cinnarizine and cyproheptadine) have been reported to be efficacious in preventing migraine. However, the proof for this is limited, and their efficacy has been ascribed other actions than the antihistaminergic. In general, lack of specificity and side effects limit the potential use of centrally acting H1 and H2 antagonists. Brain histamine is synthesized by neurons that are restricted to the posterior basal hypothalamus, more specific to the tuberomamillary nucleus (TMN), and that project practically to the whole central nervous system. The posterior hypothalamus is a suspected locus in quo in several primary headaches. Recently, a positron emission tomography study performed in the prodromal phase of migraine attacks supported the idea of initial involvement of this area. In another recent study, the thalamic nuclei receiving trigeminal output was also shown to have direct connections with the ventral TMN. The central histaminergic system plays an important role in the complex sleep-wake cycle, promoting cortical excitability during wakening and attention, and it consolidates the wake state. The period of the day, in the evenings and during the night, when there is reduced susceptibility for migraine attacks corresponds with less central histaminergic firing. Activation of both the H3 and the H4 receptor promotes inhibitory actions on neurons. The H3 receptor causes autoinhibition of the histaminergic neurons themselves, and centrally acting H3 receptor agonist prodrugs have shown to both inhibit neurogenic inflammation in dura, to induce sleep, and to produce antinociception. There are no registered ongoing studies on H3 and H4 receptor ligands in migraine. CONCLUSION The role of the central histaminergic system in migraine is largely unexplored, but findings from preclinical research may be linked to several aspects of the disorder. The histaminergic system of the brain may play an important role, especially in the initial phase of an attack, and histamine H3 and H4 receptor ligands may potentially have migraine prophylactic properties. However, the basis for this is still circumstantial, and the evidence is lacking.
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Affiliation(s)
- Karl B Alstadhaug
- Department of Neurology, Nordland Hospital Trust, Bodø, Norway; Institute of Clinical Medicine, University of Tromsø, Tromsø, Norway
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