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Seong JW, Kim Y, Kwon DR, Yang CJ, Özçakar L. Effectiveness of Novel Sympathetic Nerve Entrapment Point Injections for Chronic Migraine: A Pilot Study. Life (Basel) 2023; 14:57. [PMID: 38255672 PMCID: PMC10817430 DOI: 10.3390/life14010057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 12/26/2023] [Accepted: 12/27/2023] [Indexed: 01/24/2024] Open
Abstract
No studies to date have investigated the ability of sympathetic nerve entrapment point saline (SNEP) injections to achieve long-term pain relief in patients with migraine. Therefore, this study aimed to investigate the safety and long-term efficacy of repeat splenius capitis (SC) SNEP injections in patients with migraine (with/without tension-type headache). This retrospective, single-arm study included 12 patients with migraine. Isotonic saline was injected into their SC approximately six times for 3 months. Headache frequency, duration (hour/week), intensity (using the visual analog scale), and quality of life (using the Headache Impact Test-6) were assessed during the follow-up visits for up to 24 months after the first injection. Changes before and after treatment were assessed using repeated-measures analysis of variance. Significant reductions in headache frequency, duration, and intensity were observed at all assessment points after SNEP injections when compared with the baseline values (p < 0.05), while the patients' headache-related quality of life also improved. Treatment was continued for up to 3 months to maintain these improvements, and no worsening of status or adverse effects were observed in any of the patients over the following 24 months. Our results show that SNEP injections may offer persistent, substantial, and clinically relevant benefits in patients with migraine.
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Affiliation(s)
- Jeong Won Seong
- Department of Family Medicine, Sarang Tong-sa Research Center, 2nd Floor, 477, Jinnyangho-ro, Jinju-si 52686, Republic of Korea;
| | - Yuntae Kim
- Department of Physical Medicine and Rehabilitation, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine, 31 Suncheonhyang 6-gil, Dongnam-gu, Cheonan-si 31151, Republic of Korea;
| | - Dong Rak Kwon
- Department of Rehabilitation Medicine, Muscle Research Center, Catholic University of Daegu School of Medicine, 33 Duryugongwon-ro 17-gil, Nam-Gu, Daegu 42472, Republic of Korea
| | - Cheol-Jung Yang
- Department of Orthopedic Surgery, Bonetouch Orthopaedic Clinic, 262, Godeok-ro, Gangdong-gu, Seoul 05269, Republic of Korea;
| | - Levent Özçakar
- Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Hacettepe, Tıp Fakültesi, Altındağ/Ankara 06230, Turkey;
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Karsan N, Gosalia H, Goadsby PJ. Molecular Mechanisms of Migraine: Nitric Oxide Synthase and Neuropeptides. Int J Mol Sci 2023; 24:11993. [PMID: 37569369 PMCID: PMC10418996 DOI: 10.3390/ijms241511993] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 07/12/2023] [Accepted: 07/17/2023] [Indexed: 08/13/2023] Open
Abstract
Migraine is a common condition with disabling attacks that burdens people in the prime of their working lives. Despite years of research into migraine pathophysiology and therapeutics, much remains to be learned about the mechanisms at play in this complex neurovascular condition. Additionally, there remains a relative paucity of specific and targeted therapies available. Many sufferers remain underserved by currently available broad action preventive strategies, which are also complicated by poor tolerance and adverse effects. The development of preclinical migraine models in the laboratory, and the advances in human experimental migraine provocation, have led to the identification of key molecules likely involved in the molecular circuity of migraine, and have provided novel therapeutic targets. Importantly, the identification that vasoconstriction is neither necessary nor required for headache abortion has changed the landscape of migraine treatment and has broadened the therapy targets for patients with vascular risk factors or vascular disease. These targets include nitric oxide synthase (NOS) and several neuropeptides that are involved in migraine. The ability of NO donors and infusion of some of these peptides into humans to trigger typical migraine-like attacks has supported the development of targeted therapies against these molecules. Some of these, such as those targeting calcitonin gene-related peptide (CGRP), have already reached clinical practice and are displaying a positive outcome in migraineurs for the better by offering targeted efficacy without significant adverse effects. Others, such as those targeting pituitary adenylate cyclase activating polypeptide (PACAP), are showing promise and are likely to enter phase 3 clinical trials in the near future. Understanding these nitrergic and peptidergic mechanisms in migraine and their interactions is likely to lead to further therapeutic strategies for migraine in the future.
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Affiliation(s)
- Nazia Karsan
- Headache Group, NIHR King’s Clinical Research Facility and SLaM Biomedical Research Centre, The Wolfson Sensory, Pain and Regeneration Research Centre, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London SE5 9PJ, UK; (N.K.); (H.G.)
| | - Helin Gosalia
- Headache Group, NIHR King’s Clinical Research Facility and SLaM Biomedical Research Centre, The Wolfson Sensory, Pain and Regeneration Research Centre, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London SE5 9PJ, UK; (N.K.); (H.G.)
| | - Peter J. Goadsby
- Headache Group, NIHR King’s Clinical Research Facility and SLaM Biomedical Research Centre, The Wolfson Sensory, Pain and Regeneration Research Centre, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London SE5 9PJ, UK; (N.K.); (H.G.)
- Department of Neurology, University of California, Los Angeles, CA 90095, USA
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Korkmaz OT, Arkan S, Öncü-Kaya EM, Ateş N, Tunçel N. Vasoactive intestinal peptide (VIP) conducts the neuronal activity during absence seizures: GABA seems to be the main mediator of VIP. Neurosci Lett 2021; 765:136268. [PMID: 34571088 DOI: 10.1016/j.neulet.2021.136268] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 09/20/2021] [Accepted: 09/22/2021] [Indexed: 11/27/2022]
Abstract
Absence epilepsy is classified as a childhood generalized epilepsy syndrome with distinctive electroencephalographic patterns. The Wistar Albino Glaxo originating from Rijswijk (WAG/Rij) strain is a very well validated animal model of absence epilepsy that also shows behavioral deficits. In addition to the gastrointestinal system, VIP is highly expressed throughout numerous brain regions, and it plays crucial roles as a neurotransmitter and as a neuromodulatory, neurotrophic and neuroprotective factor in both the central and peripheral nervous systems. In this study, adult WAG/Rij rats were divided into two groups (n = 10): a group that was administered VIP (25 ng/kg i.p.) every 2 days for 15 days and an age-matched control group that was administered physiological saline. Electrical brain activity and behavior (depressive- like behavior, learning and memory and anxiety) were investigated in both groups. In addition, the extracellular concentrations of GABA and glutamate and the GABA/glutamate ratio were measured by high-performance liquid chromatography in microdialysate samples collected from the somatosensorial cortex of WAG/Rij rats. Our results demonstrated that VIP treatment significantly suppressed the total duration and number of spike wave discharges in WAG/Rij rats. However, VIP had no significant effect on behavior. VIP increased the extracellular concentration of GABA and the GABA/glutamate ratio in the somatosensory cortex. In conclusion, VIP has suppressive effects on absence seizures, possibly by increasing the GABA concentration and inducing the transformation of glutamate to GABA in the somatosensory cortex of WAG/Rij rats.
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Affiliation(s)
- Orhan Tansel Korkmaz
- Department of Physiology, Faculty of Medicine, Eskisehir Osmangazi University, 26040 Eskisehir, Turkey.
| | - Sertan Arkan
- Department of Physiology, Medical Faculty, Kocaeli University, 41380, Kocaeli, Turkey
| | - Elif Mine Öncü-Kaya
- Department of Chemistry, Science Faculty, Eskisehir Technical University, 26470 Eskisehir, Turkey
| | - Nurbay Ateş
- Department of Physiology, Medical Faculty, Kocaeli University, 41380, Kocaeli, Turkey
| | - Neşe Tunçel
- Department of Physiology, Faculty of Medicine, Eskisehir Osmangazi University, 26040 Eskisehir, Turkey
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Koyuncu Irmak D, Kilinc E, Tore F. Shared Fate of Meningeal Mast Cells and Sensory Neurons in Migraine. Front Cell Neurosci 2019; 13:136. [PMID: 31024263 PMCID: PMC6460506 DOI: 10.3389/fncel.2019.00136] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 03/20/2019] [Indexed: 12/24/2022] Open
Abstract
Migraine is a primary headache disorder which has complex neurogenic pathophysiological mechanisms still requiring full elucidation. The sensory nerves and meningeal mast cell couplings in the migraine target tissue are very effective interfaces between the central nervous system and the immune system. These couplings fall into three categories: intimacy, cross-talk and a shared fate. Acting as the immediate call-center of the neuroimmune system, mast cells play fundamental roles in migraine pathophysiology. Considerable evidence shows that neuroinflammation in the meninges is the key element resulting in the sensitization of trigeminal nociceptors. The successive events such as neuropeptide release, vasodilation, plasma protein extravasation, and mast cell degranulation that form the basic characteristics of the inflammation are believed to occur in this persistent pain state. In this regard, mast cells and sensory neurons represent both the target and source of the neuropeptides that play autocrine, paracrine, and neuro-endocrine roles during this inflammatory process. This review intends to contribute to a better understanding of the meningeal mast cell and sensory neuron bi-directional interactions from molecular, cellular, functional points of view. Considering the fact that mast cells play a sine qua non role in expanding the opportunities for targeted new migraine therapies, it is of crucial importance to explore these multi-faceted interactions.
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Affiliation(s)
- Duygu Koyuncu Irmak
- Department of Histology and Embryology, School of Medicine, Biruni University, Istanbul, Turkey
| | - Erkan Kilinc
- Department of Physiology, School of Medicine, Bolu Abant İzzet Baysal University, Bolu, Turkey
| | - Fatma Tore
- Department of Physiology, School of Medicine, Biruni University, Istanbul, Turkey
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Rice FL, Xie JY, Albrecht PJ, Acker E, Bourgeois J, Navratilova E, Dodick DW, Porreca F. Anatomy and immunochemical characterization of the non-arterial peptidergic diffuse dural innervation of the rat and Rhesus monkey: Implications for functional regulation and treatment in migraine. Cephalalgia 2016; 37:1350-1372. [DOI: 10.1177/0333102416677051] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Objective The interplay between neuronal innervation and other cell types underlies the physiological functions of the dura mater and contributes to pathophysiological conditions such as migraine. We characterized the extensive, but understudied, non-arterial diffuse dural innervation (DDI) of the rat and Rhesus monkey. Methods We used a comprehensive integrated multi-molecular immunofluorescence labeling strategy to extensively profile the rat DDI and to a lesser extent that of the Rhesus monkey. Results The DDI was distributed across a dense, pervasive capillary network and included free nerve endings of peptidergic CGRP-expressing C fibers that were closely intertwined with noradrenergic (NA) sympathetic fibers and thin-caliber nonpeptidergic “C/Aδ” fibers. These newly identified C/Aδ fibers were unmyelinated, like C fibers, but expressed NF200, usually indicative of Aδ fibers, and uniquely co-labeled for the CGRP co-receptor, RAMP1. Slightly-larger caliber NF200-positive fibers co-labeled for myelin basic protein (MBP) and terminated as unbranched corpuscular endings. The DDI peptidergic fibers co-labeled for the lectin IB4 and expressed presumably excitatory α1-adrenergic receptors, as well as inhibitory 5HT1D receptors and the delta opioid receptor (δOR), but rarely the mu opioid receptor (µOR). Labeling for P2X3, TRPV1, TRPA1, and parasympathetic markers was not observed in the DDI. Interpretation These results suggest potential functional interactions, wherein peptidergic DDI fibers may be activated by stress-related sympathetic activity, resulting in CGRP release that could be detected in the circulation. CGRP may also activate nonpeptidergic C/Aδ fibers that are likely mechanosensitive or polymodal, leading to activation of post-synaptic pain transmission circuits. The distribution of α1-adrenergic receptors, RAMP1, and the unique expression of the δOR on CGRP-expressing DDI fibers suggest strategies for functional modulation and application to therapy.
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Affiliation(s)
- Frank L Rice
- Integrated Tissue Dynamics LLC, Rensselaer, NY, USA
| | - Jennifer Y Xie
- Department of Pharmacology, Arizona Health Sciences Center, University of Arizona, Tucson, AZ, USA
| | | | - Emily Acker
- Integrated Tissue Dynamics LLC, Rensselaer, NY, USA
| | | | - Edita Navratilova
- Department of Pharmacology, Arizona Health Sciences Center, University of Arizona, Tucson, AZ, USA
| | - David W Dodick
- Departments of Collaborative Research and Neurology, Mayo Clinic, Scottsdale, AZ, USA
| | - Frank Porreca
- Department of Pharmacology, Arizona Health Sciences Center, University of Arizona, Tucson, AZ, USA
- Departments of Collaborative Research and Neurology, Mayo Clinic, Scottsdale, AZ, USA
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Kilinc E, Firat T, Tore F, Kiyan A, Kukner A, Tunçel N. Vasoactive Intestinal peptide modulates c-Fos activity in the trigeminal nucleus and dura mater mast cells in sympathectomized rats. J Neurosci Res 2014; 93:644-50. [DOI: 10.1002/jnr.23523] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Revised: 10/22/2014] [Accepted: 10/22/2014] [Indexed: 01/24/2023]
Affiliation(s)
- Erkan Kilinc
- Abant Izzet Baysal University, Institute of Health Sciences; Department of Physiology; Bolu Turkey
| | - Tülin Firat
- Abant Izzet Baysal University; Faculty of Medicine; Department of Histology and Embryology; Bolu Turkey
| | - Fatma Tore
- Sanko University; Faculty of Medicine; Department of Physiology; Gaziantep Turkey
| | - Aysu Kiyan
- Abant Izzet Baysal University; Faculty of Medicine; Department of Public Health; Bolu Turkey
| | - Aysel Kukner
- Abant Izzet Baysal University; Faculty of Medicine; Department of Histology and Embryology; Bolu Turkey
| | - Nese Tunçel
- Eskisehir Osmangazi University; Faculty of Medicine; Department of Physiology; Eskisehir Turkey
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Wei J, Yan L, Liu T, Xu W, Shi Z, Wu T, Wan Q. Cervical sympathectomy reduces neurogenic vasodilation in dura mater of rats. Auton Neurosci 2011; 162:10-4. [DOI: 10.1016/j.autneu.2011.01.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2010] [Revised: 12/22/2010] [Accepted: 01/13/2011] [Indexed: 11/16/2022]
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