1
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Labastida-Ramírez A, Caronna E, Gollion C, Stanyer E, Dapkute A, Braniste D, Naghshineh H, Meksa L, Chkhitunidze N, Gudadze T, Pozo-Rosich P, Burstein R, Hoffmann J. Mode and site of action of therapies targeting CGRP signaling. J Headache Pain 2023; 24:125. [PMID: 37691118 PMCID: PMC10494408 DOI: 10.1186/s10194-023-01644-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 08/01/2023] [Indexed: 09/12/2023] Open
Abstract
Targeting CGRP has proved to be efficacious, tolerable, and safe to treat migraine; however, many patients with migraine do not benefit from drugs that antagonize the CGRPergic system. Therefore, this review focuses on summarizing the general pharmacology of the different types of treatments currently available, which target directly or indirectly the CGRP receptor or its ligand. Moreover, the latest evidence regarding the selectivity and site of action of CGRP small molecule antagonists (gepants) and monoclonal antibodies is critically discussed. Finally, the reasons behind non-responders to anti-CGRP drugs and rationale for combining and/or switching between these therapies are addressed.
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Affiliation(s)
- Alejandro Labastida-Ramírez
- Wolfson Centre for Age-Related Diseases, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, SE1 1UL, UK
| | - Edoardo Caronna
- Headache Unit, Neurology Department, Vall d'Hebron Universitary Hospital, Barcelona, Spain
- Headache Research Group, Vall d'Hebron Institut de Recerca, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Cédric Gollion
- Department of Neurology, University Hospital of Toulouse, Toulouse, France
| | - Emily Stanyer
- Wolfson Centre for Age-Related Diseases, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, SE1 1UL, UK
- Nuffield Department of Clinical Neurosciences, Sleep and Circadian Neuroscience Institute, University of Oxford, Oxford, UK
| | | | - Diana Braniste
- Institute of Neurology and Neurosurgery, Diomid Gherman, Chișinău, Moldova
- State University of Medicine and Pharmacy, Nicolae Testemițanu, Moldova
| | - Hoda Naghshineh
- Headache Department, Iranian Center of Neurological Research, Neuroscience Institute, Tehran University of Medical Science, Tehran, Iran
| | - Liga Meksa
- Headache Unit, Neurology and Neurosurgery Department, Riga East University Hospital Gailezers, Riga, Latvia
| | | | - Tamari Gudadze
- Department of Neurology, Christian Hospital Unna, Unna, Germany
| | - Patricia Pozo-Rosich
- Headache Unit, Neurology Department, Vall d'Hebron Universitary Hospital, Barcelona, Spain
- Headache Research Group, Vall d'Hebron Institut de Recerca, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Rami Burstein
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Department of Anesthesia, Harvard Medical School, Boston, MA, USA
- Center for Life Science, Room 649, 3 Blackfan Circle, Boston, MA, 02215, USA
| | - Jan Hoffmann
- Wolfson Centre for Age-Related Diseases, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, SE1 1UL, UK.
- NIHR-Wellcome Trust King's Clinical Research Facility/SLaM Biomedical Research Centre, King's College Hospital, London, UK.
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2
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Mancuso-Marcello M, Qureshi AI, Nikola C, Stoian I, Jia Y, Saeed D, Bhogal P. Intra-arterial lidocaine therapy via the middle meningeal artery for migraine headache: Theory, current practice and future directions. Interv Neuroradiol 2023:15910199231195470. [PMID: 37574789 DOI: 10.1177/15910199231195470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/15/2023] Open
Abstract
Recent developments in neurointerventional research have seen the emergence of the middle meningeal artery (MMA) as an effective conduit for intra-arterial (IA) therapy for a number of pathologies. Here, we review the anatomical, pathophysiological and experimental basis for utilisation of the MMA for IA treatment of migraine headache. We explore the in-human case literature for the treatment of headaches with IA lidocaine and discuss considerations and challenges for future research.
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Affiliation(s)
| | - Adnan I Qureshi
- Zeenat Qureshi Stroke Institute and Department of Neurology, University of Missouri, Columbia, MO, USA
| | | | | | - YiFan Jia
- Imperial College School of Medicine, Imperial College London, London, UK
| | | | - Pervinder Bhogal
- Interventional Neuroradiology, Barts Health NHS Trust, London, UK
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3
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Abstract
Migraine is a complex neurovascular pain disorder linked to the meninges, a border tissue innervated by neuropeptide-containing primary afferent fibers chiefly from the trigeminal nerve. Electrical or mechanical stimulation of this nerve surrounding large blood vessels evokes headache patterns as in migraine, and the brain, blood, and meninges are likely sources of headache triggers. Cerebrospinal fluid may play a significant role in migraine by transferring signals released from the brain to overlying pain-sensitive meningeal tissues, including dura mater. Interactions between trigeminal afferents, neuropeptides, and adjacent meningeal cells and tissues cause neurogenic inflammation, a critical target for current prophylactic and abortive migraine therapies. Here we review the importance of the cranial meninges to migraine headaches, explore the properties of trigeminal meningeal afferents, and briefly review emerging concepts, such as meningeal neuroimmune interactions, that may one day prove therapeutically relevant.
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Affiliation(s)
- Dan Levy
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA;
| | - Michael A Moskowitz
- Center for Systems Biology and Departments of Radiology and Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA;
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4
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Exploring Novel Therapeutic Targets in the Common Pathogenic Factors in Migraine and Neuropathic Pain. Int J Mol Sci 2023; 24:ijms24044114. [PMID: 36835524 PMCID: PMC9959352 DOI: 10.3390/ijms24044114] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 02/08/2023] [Accepted: 02/15/2023] [Indexed: 02/22/2023] Open
Abstract
Migraine and neuropathic pain (NP) are both painful, disabling, chronic conditions which exhibit some symptom similarities and are thus considered to share a common etiology. The calcitonin gene-related peptide (CGRP) has gained credit as a target for migraine management; nevertheless, the efficacy and the applicability of CGRP modifiers warrant the search for more effective therapeutic targets for pain management. This scoping review focuses on human studies of common pathogenic factors in migraine and NP, with reference to available preclinical evidence to explore potential novel therapeutic targets. CGRP inhibitors and monoclonal antibodies alleviate inflammation in the meninges; targeting transient receptor potential (TRP) ion channels may help prevent the release of nociceptive substances, and modifying the endocannabinoid system may open a path toward discovery of novel analgesics. There may exist a potential target in the tryptophan-kynurenine (KYN) metabolic system, which is closely linked to glutamate-induced hyperexcitability; alleviating neuroinflammation may complement a pain-relieving armamentarium, and modifying microglial excitation, which is observed in both conditions, may be a possible approach. Those are several potential analgesic targets which deserve to be explored in search of novel analgesics; however, much evidence remains missing. This review highlights the need for more studies on CGRP modifiers for subtypes, the discovery of TRP and endocannabinoid modulators, knowledge of the status of KYN metabolites, the consensus on cytokines and sampling, and biomarkers for microglial function, in search of innovative pain management methods for migraine and NP.
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5
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Terrier LM, Bergemer AM, Destrieux C, Maldonado IL. Anatomical study of the carotid-trigeminal interface: The missing link in the trigeminovascular system? J Anat 2022; 241:1303-1309. [PMID: 36156796 DOI: 10.1111/joa.13765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 08/27/2022] [Accepted: 08/29/2022] [Indexed: 11/30/2022] Open
Abstract
The trigeminal system is considered a prominent actor in brain nociceptive innervation. The trigeminovascular system is mainly composed of pseudounipolar neurons located within the trigeminal ganglion, whose dendrites originate in cerebral blood vessels. Anatomical studies demonstrating anatomical continuity between perivascular fibers and the trigeminal system are lacking. This issue is addressed in this study. Eleven cadaveric heads obtained from a body donation program were fixed in formalin. We performed a microanatomical study of the cavernous carotid-trigeminal interface and a histological examination of the tissue bridges crossing the virtual space between the medial aspect of the trigeminal ganglion and ophthalmic nerve and the lateral aspect of the cavernous segment of the internal carotid artery. Very strong adhesion was observed between the horizontal segment of the artery and the ophthalmic nerve in all specimens. The virtual space in this interface was crossed by a web of delicate filaments. Histological examination demonstrated the presence of nerve fibers in all samples. In this study, the carotid-trigeminal interface has been described in greater detail than ever before and could provide insight into disorders related to the trigeminovascular system. As the present results do not allow the exact nature of the axons to be affirmed, further investigation is necessary.
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Affiliation(s)
- Louis-Marie Terrier
- Department of Neurosurgery, Clairval Private Hospital, Ramsay Generale de Santé, Marseille, France.,UMR 1253, iBrain, Université de Tours, Inserm, Tours, France
| | | | - Christophe Destrieux
- UMR 1253, iBrain, Université de Tours, Inserm, Tours, France.,Service de Neurochirurgie, CHRU de Tours, Tours, France
| | - Igor Lima Maldonado
- UMR 1253, iBrain, Université de Tours, Inserm, Tours, France.,Service de Neurochirurgie, CHRU de Tours, Tours, France
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6
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The trigeminal pathways. J Neurol 2022; 269:3443-3460. [DOI: 10.1007/s00415-022-11002-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Revised: 01/29/2022] [Accepted: 01/29/2022] [Indexed: 12/14/2022]
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7
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Tajti J, Szok D, Nyári A, Vécsei L. CGRP and CGRP-receptor as targets of migraine therapy: Brain Prize-2021. CNS & NEUROLOGICAL DISORDERS-DRUG TARGETS 2021; 21:460-478. [PMID: 34635045 DOI: 10.2174/1871527320666211011110307] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 08/11/2021] [Accepted: 08/14/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Migraine is a highly prevalent primary headache with an unclear pathomechanism. During the last 40 years numerous hypotheses have arisen, among them the theory of the trigeminovascular system is the primary one. It serves as a skeleton in successful preclinical studies and in the development of effective therapeutic options for migraine headache. OBJECTIVE The Brain Prize (awarded annually by the Lundbeck Foundation) is the most prestigious tribute in neuroscience. The winners in 2021 were Lars Edvinsson, Peter Goadsby, Michael Moskowitz and Jes Olesen. They are the fathers of the migraine pathomechanism which led to revolutionary new treatments. This review summarizes their landmark findings. METHODS Data related to this topic were reviewed from PubMed records published between 1979 and May 2021. Searches were based on preclinical and clinical studies in the covered field. The findings were listed in chronological order. From a therapeutic perspective, only randomized controlled trials and meta-analysis were discussed. RESULTS The calcitonin gene-related peptide-related pathogenesis of migraine is based on the activation of the trigeminovascular system. The therapeutic triad for migraine is triptans, gepants and calcitonin gene-related peptide-targeted monoclonal antibodies. CONCLUSION In the past 40 years, the systematic work of leading headache scientists has resulted in robust theoretical and therapeutic knowledge in the preclinical and clinical study of migraine.
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Affiliation(s)
- János Tajti
- Department of Neurology, Faculty of Medicine, Albert Szent-Györgyi Clinical Center, University of Szeged, Semmelweis u. 6, H-6725, Szeged. Hungary
| | - Délia Szok
- Department of Neurology, Faculty of Medicine, Albert Szent-Györgyi Clinical Center, University of Szeged, Semmelweis u. 6, H-6725, Szeged. Hungary
| | - Aliz Nyári
- Department of Neurology, Faculty of Medicine, Albert Szent-Györgyi Clinical Center, University of Szeged, Semmelweis u. 6, H-6725, Szeged. Hungary
| | - László Vécsei
- Department of Neurology, Faculty of Medicine, Albert Szent-Györgyi Clinical Center, University of Szeged, Semmelweis u. 6, H-6725, Szeged. Hungary
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8
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Terrier LM, Fontaine D. Intracranial nociception. Rev Neurol (Paris) 2021; 177:765-772. [PMID: 34384629 DOI: 10.1016/j.neurol.2021.07.012] [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: 07/14/2021] [Revised: 07/23/2021] [Accepted: 07/23/2021] [Indexed: 11/29/2022]
Abstract
Understanding intracranial nociceptive innervation is essential to understand the pathophysiology of headaches. Our knowledge about human intracranial nociception comes from sparse observations during neurosurgical procedures performed in awake patients, from human anatomical studies and from experimental studies in animals. In this article we review the anatomical and functional organization underlying nociceptive innervation. Intracranial nociception is mainly mediated by the trigeminal system, except in the posterior cranial fossa that is innervated by the first cervical roots. For decades, the dura mater, its vessels and major cerebral blood vessels were considered as the only intracranial pain-sensitive structures. Recent animal and human studies have suggested that smaller brain arteries and potentially pia mater might also be pain sensitive. Nociceptive neurons innervating intracranial blood vessels project via the ophthalmic division (V1) to the trigeminal ganglion and store several neurotransmitters including glutamate, substance P and calcitonin gene-related peptide (CGRP). The trigeminal ganglion, root and brainstem nuclei have a specific topographic and functional somatotopy. Progressive transition between the trigeminal spinal nucleus and the dorsal horn of the cervical spinal cord, and convergence of nociceptive inputs from the face, intracranial structures and the occipital area on the so-called "trigemino-cervical complex" may explain some headache features, relations between facial and occipital pain, and efficacy of occipital nerve stimulation in headache. The specific anatomic organization of the trigeminal system, from the primary-order neuron in the trigeminal ganglion, to the second-order neuron is the trigeminal nuclei, may explain a part of the various characteristics of headaches.
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Affiliation(s)
- L-M Terrier
- Department of Neurosurgery, CHRU de Tours, U1253, 10, Boulevard Tonnellé, 37032 Tours, France; UMR 1253, ibrain, Université de Tours, Inserm, Tours, France.
| | - D Fontaine
- Department of Neurosurgery, CHU de Nice, Université Cote d'Azur, Nice, France; Université Cote d'Azur, FHU INOVPAIN, CHU de Nice, Nice, France
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9
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Edvinsson L. CGRP and migraine; from bench to bedside. Rev Neurol (Paris) 2021; 177:785-790. [PMID: 34275653 DOI: 10.1016/j.neurol.2021.06.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 06/18/2021] [Indexed: 01/12/2023]
Abstract
Migraine treatment has reached a new era with the development of drugs that target the trigeminal neuropeptide calcitonin gene-related peptide (CGRP) or its receptor. The CGRP related therapies offer considerable improvements over existing drugs as they are the first to be designed to act on the trigeminal pain system, more specific and with few adverse events. Small molecule CGRP receptor antagonists, such as rimegepant and ubrogepant, are effective for the acute treatment of migraine headache. In contrast, monoclonal antibodies against CGRP or the CGRP receptor are beneficial for the prophylactic treatments in chronic migraine. Here I will provide a historical overview of the long path that led to their successful development. In addition, I will discuss aspects on the biology of CGRP signalling, the role of CGRP in migraine headache, the efficacy of CGRP targeted treatment, and synthesize what currently is known about the role of CGRP in the trigeminovascular system.
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Affiliation(s)
- L Edvinsson
- Department of Medicine, University Hospital, 22185 Lund, Sweden.
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10
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Terrier LM, Hadjikhani N, Velut S, Magnain C, Amelot A, Bernard F, Zöllei L, Destrieux C. The trigeminal system: The meningovascular complex- A review. J Anat 2021; 239:1-11. [PMID: 33604906 DOI: 10.1111/joa.13413] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 02/02/2021] [Accepted: 02/03/2021] [Indexed: 12/12/2022] Open
Abstract
Supratentorial sensory perception, including pain, is subserved by the trigeminal nerve, in particular, by the branches of its ophthalmic division, which provide an extensive innervation of the dura mater and of the major brain blood vessels. In addition, contrary to previous assumptions, studies on awake patients during surgery have demonstrated that the mechanical stimulation of the pia mater and small cerebral vessels can also produce pain. The trigeminovascular system, located at the interface between the nervous and vascular systems, is therefore perfectly positioned to detect sensory inputs and influence blood flow regulation. Despite the fact that it remains only partially understood, the trigeminovascular system is most probably involved in several pathologies, including very frequent ones such as migraine, or other severe conditions, such as subarachnoid haemorrhage. The incomplete knowledge about the exact roles of the trigeminal system in headache, blood flow regulation, blood barrier permeability and trigemino-cardiac reflex warrants for an increased investigation of the anatomy and physiology of the trigeminal system. This translational review aims at presenting comprehensive information about the dural and brain afferents of the trigeminovascular system, in order to improve the understanding of trigeminal cranial sensory perception and to spark a new field of exploration for headache and other brain diseases.
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Affiliation(s)
- Louis-Marie Terrier
- UMR 1253, ibrain, Université de Tours, Inserm, Tours, France.,CHRU de Tours, Tours, France
| | - Nouchine Hadjikhani
- Martinos Center for Biomedical Imaging, Harvard Medical School/MGH/MIT, Boston, MA, USA
| | - Stéphane Velut
- UMR 1253, ibrain, Université de Tours, Inserm, Tours, France.,CHRU de Tours, Tours, France
| | - Caroline Magnain
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA
| | - Aymeric Amelot
- UMR 1253, ibrain, Université de Tours, Inserm, Tours, France.,CHRU de Tours, Tours, France
| | | | - Lilla Zöllei
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA
| | - Christophe Destrieux
- UMR 1253, ibrain, Université de Tours, Inserm, Tours, France.,CHRU de Tours, Tours, France
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11
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Edvinsson JCA, Viganò A, Alekseeva A, Alieva E, Arruda R, De Luca C, D'Ettore N, Frattale I, Kurnukhina M, Macerola N, Malenkova E, Maiorova M, Novikova A, Řehulka P, Rapaccini V, Roshchina O, Vanderschueren G, Zvaune L, Andreou AP, Haanes KA. The fifth cranial nerve in headaches. J Headache Pain 2020; 21:65. [PMID: 32503421 PMCID: PMC7275328 DOI: 10.1186/s10194-020-01134-1] [Citation(s) in RCA: 74] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 05/25/2020] [Indexed: 12/27/2022] Open
Abstract
The fifth cranial nerve is the common denominator for many headaches and facial pain pathologies currently known. Projecting from the trigeminal ganglion, in a bipolar manner, it connects to the brainstem and supplies various parts of the head and face with sensory innervation. In this review, we describe the neuroanatomical structures and pathways implicated in the sensation of the trigeminal system. Furthermore, we present the current understanding of several primary headaches, painful neuropathies and their pharmacological treatments. We hope that this overview can elucidate the complex field of headache pathologies, and their link to the trigeminal nerve, to a broader field of young scientists.
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Affiliation(s)
- J C A Edvinsson
- Department of Clinical Experimental Research, Glostrup Research Institute, Rigshospitalet Glostrup, 2600, Glostrup, Denmark. .,Department of Drug Design and Pharmacology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
| | - A Viganò
- IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy
| | - A Alekseeva
- Department of Neurology, First Pavlov State Medical University of St.Petersburg, St.Petersburg, Russia
| | - E Alieva
- GBUZ Regional Clinical Hospital № 2, Krasnodar, Russia
| | - R Arruda
- Department of Neuroscience, University of Sao Paulo, Ribeirao Preto, Brazil
| | - C De Luca
- Department of Clinical and Experimental Medicine, Neurology Unit, University of Pisa, 56126, Pisa, Italy.,Department of Public Medicine, Laboratory of Morphology of Neuronal Network, University of Campania-Luigi Vanvitelli, Naples, Italy
| | - N D'Ettore
- Department of Neurology, University of Rome, Tor Vergata, Rome, Italy
| | - I Frattale
- Department of Applied Clinical Sciences and Biotechnology, University of L'Aquila, 67100, L'Aquila, Italy
| | - M Kurnukhina
- Department of Neurosurgery, First Pavlov State Medical University of St.Petersburg, Lev Tolstoy Street 6-8, St.Petersburg, Russia.,The Leningrad Regional State Budgetary Institution of health care "Children's clinical hospital", St.Petersburg, Russia
| | - N Macerola
- Department of Internal Medicine, Fondazione Policlinico Universitario Agostino Gemelli IRCCS Università Cattolica del Sacro Cuore, Rome, Italy
| | - E Malenkova
- Pain Department, Petrovsky National Research Centre of Surgery, Moscow, Russia
| | - M Maiorova
- Faculty of Medicine, University of Tartu, Tartu, Estonia
| | - A Novikova
- F.F. Erisman Federal Research Center for Hygiene, Mytishchy, Russia
| | - P Řehulka
- Department of Neurology, St. Anne's University Hospital and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - V Rapaccini
- Child Neurology and Psychiatry Unit, Systems Medicine Department, University Hospital Tor Vergata, Viale Oxford 81, 00133, Rome, Italy.,Unità Sanitaria Locale (USL) Umbria 2, Viale VIII Marzo, 05100, Terni, Italy.,Department of Neurology, Headache Center, Ospedale Pediatrico Bambino Gesù, IRCCS, Rome, Italy
| | - O Roshchina
- Department of Neurology, First Pavlov State Medical University of St.Petersburg, St.Petersburg, Russia
| | - G Vanderschueren
- Department of Neurology, ZNA Middelheim, Lindendreef 1, 2020, Antwerp, Belgium
| | - L Zvaune
- Department of Anaesthesiology and Intensive Care, Faculty of Medicine, Riga Stradins University, Riga, Latvia.,Department of Pain Medicine, Hospital Jurmala, Jurmala, Latvia.,Headache Centre Vivendi, Riga, Latvia
| | - A P Andreou
- Headache Research, Wolfson CARD, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,The Headache Centre, Guy's and St Thomas, NHS Foundation Trust, London, UK
| | - K A Haanes
- Department of Clinical Experimental Research, Glostrup Research Institute, Rigshospitalet Glostrup, 2600, Glostrup, Denmark
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12
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Ashina M, Hansen JM, Do TP, Melo-Carrillo A, Burstein R, Moskowitz MA. Migraine and the trigeminovascular system-40 years and counting. Lancet Neurol 2019; 18:795-804. [PMID: 31160203 DOI: 10.1016/s1474-4422(19)30185-1] [Citation(s) in RCA: 263] [Impact Index Per Article: 52.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 03/28/2019] [Accepted: 04/04/2019] [Indexed: 12/15/2022]
Abstract
The underlying causes of migraine headache remained enigmatic for most of the 20th century. In 1979, The Lancet published a novel hypothesis proposing an integral role for the neuropeptide-containing trigeminal nerve. This hypothesis led to a transformation in the migraine field and understanding of key concepts surrounding migraine, including the role of neuropeptides and their release from meningeal trigeminal nerve endings in the mechanism of migraine, blockade of neuropeptide release by anti-migraine drugs, and activation and sensitisation of trigeminal afferents by meningeal inflammatory stimuli and upstream role of intense brain activity. The study of neuropeptides provided the first evidence that antisera directed against calcitonin gene-related peptide (CGRP) and substance P could neutralise their actions. Successful therapeutic strategies using humanised monoclonal antibodies directed against CGRP and its receptor followed from these findings. Nowadays, 40 years after the initial proposal, the trigeminovascular system is widely accepted as having a fundamental role in this highly complex neurological disorder and provides a road map for future migraine therapies.
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Affiliation(s)
- Messoud Ashina
- Danish Headache Center, Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
| | - Jakob Møller Hansen
- Danish Headache Center, Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Thien Phu Do
- Danish Headache Center, Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Agustin Melo-Carrillo
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Rami Burstein
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Michael A Moskowitz
- Department of Neurology and Department of Radiology, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
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13
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Huang P, Kuo PH, Lee MT, Chiou LC, Fan PC. Age-Dependent Anti-migraine Effects of Valproic Acid and Topiramate in Rats. Front Pharmacol 2018; 9:1095. [PMID: 30319425 PMCID: PMC6167431 DOI: 10.3389/fphar.2018.01095] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 09/07/2018] [Indexed: 01/18/2023] Open
Abstract
Background: Valproic acid (VPA) and topiramate (TPM), initially developed as antiepileptics, are approved for migraine prophylaxis in adults but not children. The differences in their antimigraine mechanism(s) by age remain unclear. Methods: A migraine model induced by intra-cisternal (i.c.) capsaicin instillation in pediatric (4–5 weeks) and adult (8–9 weeks) rats was pretreated with VPA (30, 100 mg/kg) or TPM (10, 30, 100 mg/kg). Noxious meningeal stimulation by the irritant capsaicin triggered trigeminovascular system (TGVS) activation mimicking migraine condition, which were assessed peripherally by the depletion of calcitonin gene-related peptide (CGRP) in sensory nerve fibers of the dura mater, the increased CGRP immunoreactivity at trigeminal ganglia (TG) and centrally by the number of c-Fos-immunoreactive (c-Fos-ir) neurons in the trigeminocervical complex (TCC). Peripherally, CGRP released from dural sensory nerve terminals of TG triggered pain signal transmission in the primary afferent of trigeminal nerve, which in turn caused central sensitization of the TGVS due to TCC activation and hence contributed to migraine. Results: In the VPA-treated group, the central responsiveness expressed by reducing the number of c-Fos-ir neurons, which had been increased by i.c. capsaicin, was significant in pediatric, but not adult, rats. Inversely, VPA was effective in peripheral inhibition of elevated CGRP immunoreactivity in the TG and CGRP depletion in the dura mater of adult, but not pediatric, rats. In TPM group, the central responsiveness was significant in both adult and pediatric groups. Peripherally, TPM significantly inhibited capsaicin-induced CGRP expression of TG in adult, but not pediatric, rats. Interestingly, the capsaicin-induced depletion of CGRP in dura was significantly rescued by TPM at high doses in adults, but at low dose in pediatric group. Conclusion: These results suggest VPA exerted peripheral inhibition in adult, but central suppression in pediatric migraine-rats. In contrast, TPM involves both central and peripheral inhibition of migraine with an optimal therapeutic window in both ages. These findings may clarify the age-dependent anti-migraine mechanism of VPA and TPM, which may guide the development of new pediatric anti-migraine drugs in the future.
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Affiliation(s)
- Pokai Huang
- Department of Pediatrics, E-da Dachang Hospital, Kaohsiung, Taiwan
| | - Ping-Hung Kuo
- Department of Internal Medicine, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Ming Tatt Lee
- Graduate Institute of Brain and Mind Sciences, College of Medicine, National Taiwan University, Taipei, Taiwan.,Graduate Institute of Pharmacology, College of Medicine, National Taiwan University, Taipei, Taiwan.,Faculty of Pharmaceutical Sciences, UCSI University, Kuala Lumpur, Malaysia
| | - Lih-Chu Chiou
- Graduate Institute of Brain and Mind Sciences, College of Medicine, National Taiwan University, Taipei, Taiwan.,Graduate Institute of Pharmacology, College of Medicine, National Taiwan University, Taipei, Taiwan.,Graduate Institute of Acupuncture Science, China Medical University, Taichung, Taiwan
| | - Pi-Chuan Fan
- Department of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
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Abstract
Migraine headache is the first neurological condition treatable by a drug targeted to a specific receptor binding site. Originally viewed as a disorder of brain blood vessels, migraine may have as its biological basis a disturbance in brain function. Regarding therapy, recent molecular data document that 5-HT1D receptors on primary afferent fibers are coupled to inhibition of neuropeptide release, blockade of neurogenic inflammation, and c-fos expression within the trigeminal nucleus caudalis after noxious meningeal stimulation in experimental animals. The 5-HT1Dα receptor subtype (as opposed to the 5-HT 1Dβ receptor) has emerged as an important therapeutic target aimed at blocking trigeminal nerve fibers without constricting vascular smooth muscle. NEUROSCIENTIST 2:191-200, 1996
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Affiliation(s)
- Michael A. Moskowitz
- Stroke and Neurovascular Regulation Laboratory Departments
of Neurosurgery and Neurology Harvard Medical School Massachusetts General
Hospital Charlestown, Massachusetts
| | - Christian Waeber
- Stroke and Neurovascular Regulation Laboratory Departments
of Neurosurgery and Neurology Harvard Medical School Massachusetts General
Hospital Charlestown, Massachusetts
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Buture A, Gooriah R, Nimeri R, Ahmed F. Current Understanding on Pain Mechanism in Migraine and Cluster Headache. Anesth Pain Med 2016; 6:e35190. [PMID: 27642579 PMCID: PMC5018152 DOI: 10.5812/aapm.35190] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Revised: 02/15/2016] [Accepted: 03/02/2016] [Indexed: 02/08/2023] Open
Abstract
CONTEXT Migraine and cluster headache are undoubtedly painful conditions. The respective pathogenesis of these two conditions is incompletely understood. In both cases, the treatments used have largely been empirical and have relied to a much lesser extent on our understanding of the mechanisms causing pain. We hereby review the pain mechanisms in migraine and cluster headache, two of the commonest primary headache disorders. EVIDENCE ACQUISITION A review of the English literature was conducted by searching PubMed for studies on pain mechanism in migraine and cluster headache. We entered [migraine] and [pain mechanism] in Pubmed and 488 articles were obtained. Articles were then included according to their relevance to the topic. Similarly, [cluster headache] and [pain mechanism] revealed 79 search results. RESULTS There is evidence that the trigeminovascular system and neurogenic inflammation play important roles, together with certain areas of the brain, leading to these conditions being termed 'neurovascular headaches'. Functional imaging findings suggest a possible role of the dorsolateral pons in generating migraine attacks while the role of the hypothalamus in cluster headache is more firmly established. CONCLUSIONS Migraine and cluster headache have complex pathophysiologies. The exact mechanism causing pain in both conditions is incompletely understood and more research needs to be undertaken in this area.
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Affiliation(s)
- Alina Buture
- Department of Neurology, Hull Royal Infirmary, Hull, UK
| | | | - Randa Nimeri
- Department of Neurology, Hull Royal Infirmary, Hull, UK
| | - Fayyaz Ahmed
- Department of Neurology, Hull Royal Infirmary, Hull, UK
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Ulvi H, Demir R, Aygül R, Kotan D, Çalik M, Aydin MD. Effects of ischemic phrenic nerve root ganglion injury on respiratory disturbances in subarachnoid hemorrhage: an experimental study. Arch Med Sci 2013; 9:1125-31. [PMID: 24482661 PMCID: PMC3902712 DOI: 10.5114/aoms.2013.39227] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2011] [Revised: 10/24/2011] [Accepted: 11/19/2011] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Phrenic nerves have important roles on the management of respiration rhythm. Diaphragm paralysis is possible in phrenic nerve roots ischemia in subarachnoid hemorrhage (SAH). We examined whether there is a relationship between phrenic nerve root ischemia and respiratory disturbances in SAH. MATERIAL AND METHODS This study was conducted on 5 healthy control and 14 rabbits with experimentally induced SAH by injecting autologous blood into their cisterna magna. Animals were followed up via monitors for detecting the heart and respiration rhythms for 20 days and then decapitaed by humanely. Normal and degenerated neuron densities of phrenic nerve root at the level of C4 dorsal root ganglia (C4DRG) were estimated by Stereological methods. Between the mean numerical density of degenerated neurons of C4DRG and respiratory rate/minute of groups were compared statistically. RESULTS Phrenic nerve roots, artery and diaphragm muscles degeneration was detected in respiratory arrest developed animals. The mean neuronal density of C4DRG was 13272 ±1201/mm3 with a mean respiration rate of 23 ±4/min in the control group. The mean degenerated neuron density was 2.240 ±450/mm(3) and respiration rhythm was 31 ±6/min in survivors. But, the mean degenerated neuron density was 5850 ±650/mm(3) and mean respiration rhythm was 34 ±7/min in respiratory arrest developed animals (n = 7). A linear relationship was noticed between the degenerated neuron density of C4DRG and respiraton rate (r = -0.758; p < 0.001). CONCLUSIONS Phrenic nerve root ischemia may be an important factor in respiration rhythms deteriorations in SAH which has not been mentioned in the literature.
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Affiliation(s)
- Hızır Ulvi
- Department of Neurology, Faculty of Medicine, Atatürk University, Erzurum, Turkey
| | - Recep Demir
- Department of Neurology, Faculty of Medicine, Atatürk University, Erzurum, Turkey
| | - Recep Aygül
- Department of Neurology, Faculty of Medicine, Atatürk University, Erzurum, Turkey
| | - Dilcan Kotan
- Department of Neurology, Faculty of Medicine, Atatürk University, Erzurum, Turkey
| | - Muhammet Çalik
- Department of Pathology, Faculty of Medicine, Atatürk University, Erzurum, Turkey
| | - Mehmet Dumlu Aydin
- Department of Neurosurgery, Faculty of Medicine, Atatürk University, Erzurum, Turkey
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Abstract
This article concerns the possible role of dural changes in migraine pain. The hypothesis that changes in the dura are important in migraine pain has become widely accepted among migraine scientists. A critical examination of the evidence for and against dural involvement in migraine pain shows that in spite of the extensive research that has been carried out on dural physiology and pathophysiology, there is no hard evidence that dural changes actually occur in humans during a migraine. On the contrary, the available evidence appears to indicate that it is unlikely that dural changes are part of the migraine pain process.
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Affiliation(s)
- Elliot Shevel
- The Headache Clinic, Suite 256, P Bag X2600, Houghton 2041, South Africa
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The Relationship Between the Neuron Density of the Trigeminal Ganglion and the Posterior Communicating Artery Vasospasm in Subarachnoid Hemorrhage. ACTA ACUST UNITED AC 2012. [DOI: 10.1097/wnq.0b013e3182011683] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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19
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Yilmaz A, Gündoğdu C, Aydin MD, Musluman M, Kanat A, Aydin Y. Trigeminal ganglion neuron density and regulation of anterior choroid artery vasospasm: In a rabbit model of subarachnoid hemorrhage. Surg Neurol Int 2011; 2:77. [PMID: 21748030 PMCID: PMC3130438 DOI: 10.4103/2152-7806.82084] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2011] [Accepted: 05/17/2011] [Indexed: 12/24/2022] Open
Abstract
Background: Subarachnoid hemorrhage (SAH) is associated with severe vasospasm caused by a variety of neurochemical mechanisms. The anterior choroid arteries (AChAs) are innervated by vasodilated fibers of the trigeminal ganglion (TGG). The goal of this study was to determine whether there is a relationship between the neuron density of the TGG and the severity of AChAs vasospasm with SAH. Methods: Thirty-two rabbits were used for the study; eight served as the baseline control group, seven as a SHAM group, with injections of 1 cc of isotonic saline solution, and 17 rabbits were included in the experimental SAH group, with injection of homologous blood into the cisterna magna. After 10 days, the histopathology of the AChAs and TGGs were examined. The AChAs vasospasm index (VSI) of the external/internal diameter and the neuron density of the ophthalmic root of the TGGs were evaluated stereologically. The AChAs VSI was preferred -- a measure of the degree of vasospasm. As the VSI increased, the degree of arterial vasospasm increased. The results were statistically analyzed. Results: The mean AChAs VSI was significantly higher and the mean neuronal density of the ophthalmic root of the TGG was significantly lower in the group with severe vasospasm associated with SAH compared to the controls, SHAM, and the group with mild vasospasm associated with SAH (P< 0.05). The ophthalmic root of the TGG neuron density in the 7 rabbits that developed severe vasospasm was statistically less than that observed in the 10 rabbits with mild vasospasm. There was a linear relationship between the low neuronal density in the ophthalmic root of the TGG and the severity of the AChA vasospasm. Conclusions: The trigeminal ganglion neuron density may be an important factor in the regulation of AChAs diameter and cerebral blood flow. Low neuron density of the ophthalmic root of the TGG may play a role in the pathogenesis of AChAs vasospasm associated with SAH.
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Affiliation(s)
- Adem Yilmaz
- Department of Neurosurgery, Sisli Research and Education Hospital, Istanbul, Turkey
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20
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Kanat A, Yilmaz A, Aydin MD, Musluman M, Altas S, Gursan N. Role of degenerated neuron density of dorsal root ganglion on anterior spinal artery vasospasm in subarachnoid hemorrhage: experimental study. Acta Neurochir (Wien) 2010; 152:2167-72. [PMID: 20835838 DOI: 10.1007/s00701-010-0793-4] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2010] [Accepted: 08/30/2010] [Indexed: 11/28/2022]
Abstract
BACKGROUND The spinal arteries are innervated by several systems that contribute to the control of spinal cord blood flow. The sensory fibers of upper cervical nerves have vasodilatatory effect on the anterior spinal arteries (ASA). Subarachnoid hemorrhage (SAH) causes severe vasospasm by various neurochemical mechanisms. We examined whether there is a relationship between the neuron density of the C3 dorsal root ganglion and the severity of ASA vasospasm in SAH. METHODS This study was conducted on 20 rabbits. Four of them were used as baseline group. Experimental SAH has been applied to all of 16 animals by injecting homologous blood into cisterna magna. After 20 days of injection, ASA and C3 dorsal root ganglia (C3DRG) were examined histopathologically. ASA volume values and normal and degenerated neuron densities of C3DRG were estimated stereologically and the results were analyzed statistically. RESULTS The mean ASA volume was 1.050±0.450 mm³, [corrected] and the mean neuronal density of C3DRG was 10,500 ± 850 in all animals. The mean volume value of ASA was 0.970±0.150 [corrected] mm³, and the normal neuron density of C3DRG fell to 8,600 ± 400/mm³ in slight vasospasm group. In severe vasospasm-developed animals, mean volume value of ASA was 0.540±0.90 [corrected]mm³ and the normal neuron density of C3DRG fell to 5,500 ± 360/mm³. An inverse relationship between the degenerated neuronal density of the C3DRG and ASA volume values may indicate the severity of ASA vasospasm. CONCLUSION The neuron density of C3DRG may be an important factor on the regulation of ASA volume values and the continuation of spinal cord blood flow. Low neuron density of C3DRG may be considered as an important factor in the pathogenesis of severe ASA vasospasm in SAH.
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Affiliation(s)
- Ayhan Kanat
- Department of Neurosurgery, Rize University, Turkey.
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21
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The effects of the TRPV1 receptor antagonist SB-705498 on trigeminovascular sensitisation and neurotransmission. NAUNYN-SCHMIEDEBERG'S ARCHIVES OF PHARMACOLOGY 2009; 380:311-25. [PMID: 19690836 DOI: 10.1007/s00210-009-0437-5] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2009] [Revised: 06/01/2009] [Accepted: 07/12/2009] [Indexed: 10/20/2022]
Abstract
This report examines the effect of the transient receptor potential vanilloid 1 receptor antagonist SB-705498 on neurotransmission and inflammation-induced sensitisation in the trigeminovascular sensory system. A single-neuron electrophysiological animal model for neurovascular head pain was used to evaluate dural and facial noxious inputs and the effects of SB-705498 administered by intravenous (i.v.) injection. Electrical and mechanical stimulation of the dura mater and the facial skin activated second-order neurons in the trigeminal nucleus caudalis of cats, with A-delta latencies. Intravenous injection of SB-705498 (2 mg kg(-1)) produced a slowly developing and long-lasting suppression of responses to dural and skin stimulation. Maximum suppression occurred by 1 h and reached 41% for dura and 24% for skin. Intravenous injection of drug vehicle did not produce significant suppression of responses to stimulation of either dura or skin. Intravenous injection of SB-705498 produced a brief and small rise in blood pressure and dural blood flow, which both returned to normal before suppression of the responses to stimulation became manifest. Application of "inflammatory soup" to the dura mater produced a pronounced increase in dural blood flow and induced a slowly developing increase in the responses of neurons to both electrical and mechanical stimulations of their facial and dural receptive fields. This sensitisation reached a maximum in 60-90 min, at which time responses had risen to approximately twice that of control levels seen before the application of inflammatory soup. Intravenous injection of SB-705498 subsequent to the development of sensitisation produced a slowly developing, prolonged and statistically significant reversal of the sensitisation induced by inflammatory soup. Maximum reversal of sensitisation to electrical stimulation occurred by 150-180 min, when responses had fallen to, or below, control levels. At 70-85 min following injection of SB-705498, the responses of previously sensitised neurons to mechanical stimulation of dura mater and facial receptive field had also returned to near control levels. SB-705498 was also able to prevent the development of sensitisation; application of inflammatory soup to the dura mater induced a slowly developing increase in the responses of neurons to electrical stimulation of the skin and dura mater in cats which had received an i.v. injection of vehicle for SB-705498 but not in cats which had received the active drug. Blood levels of SB-705498 were maximal immediately following i.v. injection and declined over the following 2 h. Significant brain levels of SB-705498 were maintained for up to 9 h. These results suggest that SB-705498 may be an effective suppressant and reversal agent of the sensitisation to sensory input which follows inflammation in the trigeminovascular sensory distribution but may not be particularly useful in blocking primary pain processes such as migraine headache. SB-705498 could thus potentially prevent, modify or reverse the cutaneous trigeminal allodynia seen in certain migraine conditions, especially "transformed" migraine.
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22
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Von Frey's hairs--a review of their technology and use--a novel automated von Frey device for improved testing for hyperalgesia. J Neurosci Methods 2008; 177:420-6. [PMID: 19041344 DOI: 10.1016/j.jneumeth.2008.10.033] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2008] [Revised: 10/30/2008] [Accepted: 10/30/2008] [Indexed: 11/26/2022]
Abstract
We describe a device which allows the mechanical sensitivity of trigeminovascular sensory neurons to be monitored over extended time periods. The device can be used to stimulate either the skin or dura mater and consists of a solenoid-driven plunger to which are fixed interchangeable von Frey hairs. The solenoid can be attached to a stereotaxic carrier and mounted on a stereotaxic frame to allow precise positioning over the receptive field. The device is driven from the synchronization signals of a standard stimulator via TTL circuitry and a relay driver, to allow stimulation by a single or multiple stimuli. The advantages of the device over manual stimulation include the reproducibility of the site of stimulation; the ability to apply a known force for a known time; the ability to measure response latencies to millisecond precision and to compare them to latencies to other stimuli and; easy interface with computer-control. We discuss some of the drawbacks of the von Frey system as usually used and illustrate the use of the new device with results from experiments on peripherally induced sensitization.
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23
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24
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Affiliation(s)
- Michael A Moskowitz
- Department of Radiology, Neuroscience Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
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25
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Bergerot A, Holland PR, Akerman S, Bartsch T, Ahn AH, MaassenVanDenBrink A, Reuter U, Tassorelli C, Schoenen J, Mitsikostas DD, van den Maagdenberg AMJM, Goadsby PJ. Animal models of migraine: looking at the component parts of a complex disorder. Eur J Neurosci 2006; 24:1517-34. [PMID: 17004916 DOI: 10.1111/j.1460-9568.2006.05036.x] [Citation(s) in RCA: 101] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Animal models of human disease have been extremely helpful both in advancing the understanding of brain disorders and in developing new therapeutic approaches. Models for studying headache mechanisms, particularly those directed at migraine, have been developed and exploited efficiently in the last decade, leading to better understanding of the potential mechanisms of the disorder and of the action for antimigraine treatments. Model systems employed have focused on the pain-producing cranial structures, the large vessels and dura mater, in order to provide reproducible physiological measures that could be subject to pharmacological exploration. A wide range of methods using both in vivo and in vitro approaches are now employed; these range from manipulation of the mouse genome in order to produce animals with human disease-producing mutations, through sensitive immunohistochemical methods to vascular, neurovascular and electrophysiological studies. No one model system in experimental animals can explain all the features of migraine; however, the systems available have begun to offer ways to dissect migraine's component parts to allow a better understanding of the problem and the development of new treatment strategies.
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Affiliation(s)
- A Bergerot
- Headache Group, Institute of Neurology, and The National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
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26
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Jansen-Olesen I, Zhou M, Zinck T, Xu CB, Edvinsson L. Expression of Inducible Nitric Oxide Synthase in Trigeminal Ganglion Cells during Culture. Basic Clin Pharmacol Toxicol 2005; 97:355-63. [PMID: 16364050 DOI: 10.1111/j.1742-7843.2005.pto_195.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Nitric oxide (NO) is an important signalling molecule that has been suggested to be a key molecule for induction and maintenance of migraine attacks based on clinical studies, animal experimental studies and the expression of nitric oxide synthase (NOS) immunoreactivity within the trigeminovascular system. Sensitisation of the trigeminal system including the trigeminal ganglia neurones is believed to be involved in the pathway leading to migraine pain. In the present study, the NOS expression in rat primary trigeminal ganglia neurones was examined at different time points using immunocytochemistry, reverse transcriptase polymerase chain reaction (RT-PCR) and Western blotting. In trigeminal ganglia cells not subjected to culture, endothelial (e) and neuronal (n) but not inducible (i) NOS mRNA and protein were detected. Culture of rat neurones resulted in a rapid axonal outgrowth of NOS positive fibres. At 12, 24 and 48 hr of culture, NOS immunoreactivity was detected in medium-sized trigeminal ganglia cells. Western blotting and RT-PCR revealed an up-regulation of inducible iNOS expression during culture. However, after culture only low levels of eNOS protein was found while no eNOS and nNOS mRNA and protein could be detected. The data suggest that iNOS expression may be a molecular mechanism mediating the adaptive response of trigeminal ganglia cells to the serum free stressful stimulus the culture environment provides. It may act as a cellular signalling molecule that is expressed after cell activation.
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Affiliation(s)
- Inger Jansen-Olesen
- Department of Clinical Experimental Research, Glostrup Hospital, University of Copenhagen, 2600 Glostrup, Denmark.
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27
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Tatsui CE, Prevedello DMS, Koerbel A, Cordeiro JG, Ditzel LFDS, Araujo JC. Raeder's syndrome after embolization of a giant intracavernous carotid artery aneurysm: pathophysiological considerations. ARQUIVOS DE NEURO-PSIQUIATRIA 2005; 63:676-80. [PMID: 16172723 DOI: 10.1590/s0004-282x2005000400024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
We present the case of a 47 years old woman submitted to an endovascular trapping of a left cavernous internal carotid artery aneurysm, in which the distal balloon was inflated, as usually done, within the cavernous segment of the internal carotid artery, different from the proximal one which was inflated inside the carotid canal due to technical problems. Consequently, a clinical picture of Raeder's paratrigeminal neuralgia took place. This is the first case report in the literature with theses characteristics. A review of the anatomic pathways and further considerations about the possible pathophysiological mechanisms involved are presented.
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28
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Abstract
Calcitonin gene-related peptide (CGRP) is a potent neuromodulator that is expressed in the trigeminovascular system and is released into the cranial circulation in various primary headaches. CGRP is released in migraine, cluster headache and paroxysmal hemicrania. The blockade of its release is associated with the successful treatment of acute migraine and cluster headache. CGRP receptor blockade has recently been shown to be an effective acute anti-migraine strategy and is non-vasoconstricting in terms of the mechanism of action. The prospect of a non-vasoconstricting therapy for acute migraine offers a real opportunity to patients, and perhaps more importantly, provides a therapeutic rationale to reinforce migraine as a neurological disorder.
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Affiliation(s)
- Peter J Goadsby
- Headache Group, Institute of Neurology and The National Hospital for Neurology and Neurosurgery, London, UK.
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Gürelik M, Karadağ O, Polat S, Ozüm U, Aslan A, Gürelik B, Göksel HM. The effects of the electrical stimulation of the nasal mucosa on cortical cerebral blood flow in rabbits. Neurosci Lett 2004; 365:210-3. [PMID: 15246550 DOI: 10.1016/j.neulet.2004.04.079] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2004] [Revised: 04/19/2004] [Accepted: 04/30/2004] [Indexed: 11/24/2022]
Abstract
The cerebral vessels have sympathetic, parasympathetic, and sensory innervations. A sensory innervation of the cerebral vessels originating in the trigeminal ganglion has been described in a number of species by several investigations. It has been shown that the electrical stimulation of the trigeminal ganglion causes an increase of cerebral blood flow (CBF). The aim of our present study is to stimulate the trigeminal ganglion with an extracranial and non-invasive method. A stimulating electrode was put in the nasal mucosa via right nares of rabbits and trigeminal ganglion was stimulated orthodromically via nasociliary nerve (NCN). Variations in the cortical CBF were evaluated by laser Doppler flowmetry. In experiment group, CBF increased together with the beginning of electrical stimulation. The flow values were remained high as long as the stimulation. In post-stimulation period, the CBF was decreased gradually and returned to the baseline values at 120s. This study demonstrated that the electrical stimulation of the NCN branch of the trigeminal nerve increases the cortical CBF under physiological conditions.
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Affiliation(s)
- M Gürelik
- Department of Neurosurgery, Faculty of Medicine, Cumhuriyet University, 58140 Sivas, Turkey.
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De Marinis M, Pujia A, Natale L, D'arcangelo E, Accornero N. Decreased habituation of the R2 component of the blink reflex in migraine patients. Clin Neurophysiol 2003; 114:889-93. [PMID: 12738435 DOI: 10.1016/s1388-2457(03)00010-5] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Activation of the trigemino-vascular system as well as of brainstem trigeminal nuclei are thought to play an important role in migraine. The aim of this study was to investigate the habituation phenomenon of the blink reflex in 30 headache-free migraine patients and 30 control subjects. METHODS An electromyographic device with a specific habituation test program was used to elicit and record blink reflex responses on both the right and left sides, and to randomly repeat the stimulations at different time intervals in order to induce habituation. RESULTS Whereas the R1 and R2 latencies, amplitudes and areas in the basal assessment were similar in patients and control subjects, the blink reflex habituation responses were markedly reduced in migraine patients who had a migraine attack within 72 h after testing (group A). In these patients, the differences between the R2 areas, obtained when stimuli were delivered at subsequent time intervals ranging between 10-5, 5-4, 4-3 and 3-2 s, were statistically different (P<0.001) from those of the patients who had a migraine attack after a longer time interval (group B) and control subjects. CONCLUSIONS Our data suggest that the brainstem pathways involved in the blink reflex may be activated in the premonitory phase of migraine attacks, probably through mechanisms that involve dopaminergic function.
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Affiliation(s)
- Milena De Marinis
- Department of Neurological Sciences, La Sapienza University, Viale dell' Università 30, 00185 Rome, Italy.
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Ebel H, Semmelmann G, Schomäcker K, Balogh A, Volz M, Funke J, Schicha H, Klug N. Effects of high cervical spinal cord stimulation (CSCS) on regional cerebral blood flow after induced subarachnoid haemorrhage in rats. ACTA NEUROCHIRURGICA. SUPPLEMENT 2002; 77:225-7. [PMID: 11563293 DOI: 10.1007/978-3-7091-6232-3_48] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Affiliation(s)
- H Ebel
- Department of Neurosurgery, University of Cologne, Germany
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32
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Effects of Cerebrospinal Fluid Loss and Epidural Blood Patch on Cerebral Blood Flow in Swine. Reg Anesth Pain Med 2001. [DOI: 10.1097/00115550-200109000-00003] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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33
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Abstract
In recent years our knowledge of the nervous control of the cerebral circulation has increased. The use of denervations and retrograde tracing in combination with immunohistochemical techniques has demonstrated that cerebral vessels are supplied with sympathetic, parasympathetic, and sensory nerve fibers and possibly central pathways containing a multiplicity of new transmitter substances in addition to the classical transmitters. The majority of these transmitters are neuropeptides. More recently it has been suggested that a gaseous transmitter, nitric oxide (NO) also could participate in the neuronal regulation of cerebral blood flow. Although little is known about the physiological actions and inter-relationships among all these putative neurotransmitters, their presence within cerebrovascular nerve fibers will make it necessary to revise our view on the mechanisms of cerebrovascular neurotransmission.
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Affiliation(s)
- S Gulbenkian
- Instituto Gulbenkian de Ciência, Oeiras, Portugal
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34
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Abstract
Neuroimaging of primary headache syndromes, such as cluster headache and migraine, has begun to provide a glimpse of the neuroanatomical and physiological basis of the conditions. Although these headache types have been widely described as vascular, there is now considerable imaging and clinical evidence to suggest that they are primarily driven from the brain. The shared anatomical and physiological substrate for both of these clinical problems is the neural innervation of the cranial circulation. Functional imaging with positron emission tomography (PET) has shed light on the genesis of both syndromes, documenting activation in the midbrain and pons in migraine, and in the hypothalamic grey in cluster headache. These areas are involved not simply as a response to first division nociceptive pain impulses but specifically in each syndrome, probably in some permissive or dysfunctional role. In a recent PET study in cluster headache, as well as brain activation, tracer pooled in the region of the major basal arteries. This is likely to be due to vasodilatation of these vessels during the acute pain-attack and represents the first convincing activation of neural vasodilator mechanisms in humans. The author takes the view that the known physiology and pathophysiology of the systems involved dictate that these disorders should be collectively regarded as neurovascular headaches to place emphasis on the interaction between nerves and vessels, which is the underlying characteristic of these syndromes. Understanding this neurovascular relationship facilitates an understanding of the pain mechanisms, while characterising the CNS dysfunction will ultimately allow us to dissect out the basic pathogenesis of these disorders.
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Affiliation(s)
- P J Goadsby
- Institute of Neurology, The National Hospital for Neurology and Neurosurgery, Queen Square, London WC1N 3BG, United Kingdom.
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35
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Hoffmann O, Dirnagl U, Weber JR. The trigeminovascular system in bacterial meningitis. Microsc Res Tech 2001; 53:188-92. [PMID: 11301494 DOI: 10.1002/jemt.1083] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Headache as a cardinal symptom of acute meningitis reflects activation of trigeminal afferents from the meninges. With their perivascular endings, these fibers form the so-called trigeminovascular system (TVS), which releases proinflammatory neuropeptides upon nociceptive stimulation. In the present article, we review a role of the TVS in enhancing the early inflammatory response of bacterial meningitis. Furthermore, we discuss inhibition of neuropeptide release from the TVS using 5HT(1B/D) agonists as a potential new anti-inflammatory treatment strategy for early bacterial meningitis.
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Affiliation(s)
- O Hoffmann
- Department of Neurology, Universitaetsklinikum Charité, Humboldt University Berlin, 10098 Berlin, Germany
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36
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Kusaba H, Ando K, Fujihara N. Innervation pattern of substance P- and calcitonin gene-related peptide-immunoreactive nerves of the cerebral arteries in the quail. J Vet Med Sci 2000; 62:595-602. [PMID: 10907685 DOI: 10.1292/jvms.62.595] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The pattern of cerebrovascular substance P (SP)- and calcitonin gene-related peptide (CGRP)-immunoreactive (IR) innervation was investigated in the quail. SP- and CGRP-IR nerves were relatively a few in the rostral part of the anterior circulation, and very scanty or lacking in its caudal part and the whole of the posterior circulation. A significant finding was that the anterior circulation in the majority of individuals is furnished with a varying proportion of SP-IR nerves with or without CGRP immunoreactivity. There was a good correlation in the expression of CGRP immunoreactivity between SP-IR cells in the ophthalmic division of the trigeminal ganglion and SP-IR nerves supplying the major cerebral arteries. In the quail, SP- and CGRP-IR fiber bundles are usually present in the internal ethmoidal artery (IEA). From these and other findings, it is most probable that cerebral perivascular SP- and CGRP-IR nerves are mainly derived from the same categories of neurons in the primary sensory ganglion via the IEA. The close association of varicose SP-IR axons to the nerve cells in the pial arteries suggests that these intrinsic neurons may play some vasocontrolling roles through the modulatory effect of their pericellular SP-IR axons.
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Affiliation(s)
- H Kusaba
- Muromi Animal Hospital, Fukuoka, Japan
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37
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Schepelmann K, Ebersberger A, Pawlak M, Oppmann M, Messlinger K. Response properties of trigeminal brain stem neurons with input from dura mater encephali in the rat. Neuroscience 1999; 90:543-54. [PMID: 10215158 DOI: 10.1016/s0306-4522(98)00423-0] [Citation(s) in RCA: 74] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The responsiveness of trigeminal brain stem neurons to selective local mechanical and chemical stimulation of the cranial dura mater was examined in a preparation in the rat. The dura mater encephali was exposed and its surface stimulated with electrical pulses through bipolar electrodes. Extracellular recordings were made from neurons in the subnucleus caudalis of the spinal trigeminal nucleus. Single neurons driven by meningeal input were identified by their responses to electrical stimulation and to probing their receptive fields on the dura. Facial receptive fields were defined mechanically. Chemical stimuli (a combination of inflammatory mediators, bradykinin, prostaglandin E2, serotonin, capsaicin and acidic Tyrode's solution) were applied topically to the dura and by injection through a catheter into the superior sagittal sinus. All neurons with input from the parietal dura mater had convergent input from the facial skin, with preponderance of the periorbital region. Proportions of units were activated by the combination of inflammatory mediators (55%), bradykinin (64.5%), acidic Tyrode's solution (64.1%) and capsaicin (78.6%). We conclude that, among the chemical mediators of inflammation, bradykinin and low pH are the most effective chemical stimuli in activating meningeal nociceptors. These stimuli may be important during meningeal inflammatory processes that lead to the generation of headaches.
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Affiliation(s)
- K Schepelmann
- Neurologische Klinik der Universität Tübingen, Germany
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38
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May A, Goadsby PJ. The trigeminovascular system in humans: pathophysiologic implications for primary headache syndromes of the neural influences on the cerebral circulation. J Cereb Blood Flow Metab 1999; 19:115-27. [PMID: 10027765 DOI: 10.1097/00004647-199902000-00001] [Citation(s) in RCA: 382] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Primary headache syndromes, such as cluster headache and migraine, are widely described as vascular headaches, although considerable clinical evidence suggests that both are primarily driven from the brain. The shared anatomical and physiologic substrate for both of these clinical problems is the neural innervation of the cranial circulation. Functional imaging with positron emission tomography has shed light on the genesis of both syndromes, documenting activation in the midbrain and pons in migraine and in the hypothalamic gray in cluster headache. These areas are involved in the pain process in a permissive or triggering manner rather than as a response to first-division nociceptive pain impulses. In a positron emission tomography study in cluster headache, however, activation in the region of the major basal arteries was observed. This is likely to result from vasodilation of these vessels during the acute pain attack as opposed to the rest state in cluster headache, and represents the first convincing activation of neural vasodilator mechanisms in humans. The observation of vasodilation was also made in an experimental trigeminal pain study, which concluded that the observed dilation of these vessels in trigeminal pain is not inherent to a specific headache syndrome, but rather is a feature of the trigeminal neural innervation of the cranial circulation. Clinical and animal data suggest that the observed vasodilation is, in part, an effect of a trigeminoparasympathetic reflex. The data presented here review these developments in the physiology of the trigeminovascular system, which demand renewed consideration of the neural influences at work in many primary headaches and, thus, further consideration of the physiology of the neural innervation of the cranial circulation. We take the view that the known physiologic and pathophysiologic mechanisms of the systems involved dictate that these disorders should be collectively regarded as neurovascular headaches to emphasize the interaction between nerves and vessels, which is the underlying characteristic of these syndromes. Moreover, the syndromes can be understood only by a detailed study of the cerebrovascular physiologic mechanisms that underpin their expression.
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Affiliation(s)
- A May
- University Department of Clinical Neurology, Institute of Neurology, The National Hospital for Neurology and Neurosurgery, London, UK
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39
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Goadsby PJ, Hoskin KL. Serotonin inhibits trigeminal nucleus activity evoked by craniovascular stimulation through a 5HT1B/1D receptor: a central action in migraine? Ann Neurol 1998; 43:711-8. [PMID: 9629840 DOI: 10.1002/ana.410430605] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The development of serotonin (5HT1B/1D) agonists as treatments for the acute attack of migraine has resulted in considerable interest in their mechanism of action and, to some extent, renewed interest in the role of serotonin (5-hydroxytryptamine; 5HT) in the disorder. The initial synthesis of this class of compounds was predicated on the clinical observation that intravenous 5HT terminated acute attacks of migraine. In this study the superior sagittal sinus was isolated in the alpha-chloralose (60 mg/kg i.p. and 20 mg/kg i.v. injection supplementary 2 hourly) anesthetized cat. The sinus was stimulated electrically (120V, 250 microsec duration, 0.3 Hz), and neurons of the trigeminocervical complex in the dorsal C2 spinal cord were monitored using electrophysiological methods. After baseline recordings in each animal, 5HT (15 microg/kg/min) was infused for 5 minutes in the presence of either vehicle (group A) or the 5HT1B/1D antagonist GR127935 (100 microg/kg i.v. injection; group B). The baseline probability of cell firing after sagittal sinus stimulation was 0.61 +/- 0.1 at a latency to the fastest peak of 11.1 +/- 0.4 msec. In group A, 5HT infusion alone had a small effect of increasing mean blood pressure (12 +/- 3 mm Hg), which in itself did not alter cell firing. In group A, 5HT alone had an inhibitory effect on evoked trigeminal activity, which developed 15 to 20 minutes after commencement of the infusion. The inhibition of cell firing lasted for 20 minutes, after which the activity returned to baseline. In group B, the combination of 5HT and GR127935 had no effect on trigeminal cell firing, although the small hypertensive effect was still present. These data indicate that 5HT inhibits evoked trigeminal nucleus firing via the 5HT1B/1D receptor at which GR127935 is an antagonist. It is likely that some part of the effect of 5HT in migraine relates to inhibition of trigeminal nucleus activity, just as it is likely that some part of the effect of the triptans is also mediated at this central site and may be complementary to their nonneuronal actions. Moreover, the data highlight the case for describing this class of headache as neurovascular headaches rather than vascular headaches, to recognize the implicit contribution of the trigeminovascular system to their pathophysiology.
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Affiliation(s)
- P J Goadsby
- Institute of Neurology, National Hospital for Neurology and Neurosurgery, London, UK
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40
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Abstract
Historically, review of migraine-related vestibular symptoms has focused on the various clinical presentations that occur and the results of diagnostic studies of vestibular function. Treatment of vestibular symptoms related to migraine has been proposed similar to that used for headache control, but few examples of the effectiveness of this therapy have been published. The purpose of this study is to present the various approaches that can be used to manage vestibular symptoms related to migraine, and to evaluate the overall effectiveness of these treatment approaches. This was a retrospective review of 89 patients diagnosed with migraine-related dizziness and vertigo. The character of vestibular symptoms, pattern of cochlear symptoms, results of auditory and vestibular tests, and comorbidity factors are presented. Treatment was individualized according to symptoms and comorbidity factors, and analyzed regarding effectiveness in control of the major vestibular symptoms of episodic vertigo, positional vertigo, and nonvertiginous dizziness. Medical management included dietary changes, medication, physical therapy, lifestyle adaptations, and acupuncture. Complete or substantial control of vestibular symptoms was achieved in 68 (92%) of 74 patients complaining of episodic vertigo; in 56 (89%) of 63 patients with positional vertigo; and 56 (86%) of 65 patients with non-vertiginous dizziness. Similarly, aural fullness was completely resolved or substantially improved in 34 (85%) of 40 patients; ear pain in 10 (63%) of 16 patients; and phonophobia in 17 (89%) of 19 patients. No patient reported worsened symptoms following medical management. The conflicting concept of a central disorder (migraine) as the cause of cochlear and vestibular dysfunction that often has peripheral features is discussed.
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Affiliation(s)
- G D Johnson
- Department of Otolaryngology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire 03756, USA
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41
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Abstract
We made recordings from filaments of guinea pig nasociliary nerve to study response properties of afferent axons innervating the anterior superior sagittal sinus and surrounding dura mater. We analyzed 38 units in 14 experiments. Units were initially located with the use of mechanical stimuli, and were then characterized by their conduction velocity and sensitivities to mechanical, thermal, and chemical stimuli. Single-unit recordings revealed innervation of dura and superior sagittal sinus by slowly conducting axons, mostly in the unmyelinated range. The receptive fields were 1-30 mm2, and typically had one to three punctate spots of highest sensitivity. All units tested responded to topical application of chemical agents. Ninety-seven percent of units responded to 10(-5) M capsaicin, 79% responded to a mixture of inflammatory mediators, and 37% responded to an acidic buffer (pH 5). These data underline the importance of chemical sensitivity in intracranial sensation. Heat and cold stimuli evoked responses in 56 and 41% of units tested, respectively. Although the response patterns during heating were typical of polymodal nociceptors innervating other tissues, the thresholds were lower than for other tissues (32.3-42 degrees C). Cooling led to a phasic discharge, with thresholds between 25 and 32 degrees C. Although units had different combinations of responses to mechanical, chemical, and thermal stimuli, when grouped by their sensitivities the groups did not differ regarding mechanical thresholds or presence of ongoing activity. This suggests that meningeal primary afferents are relatively homogeneous. Sensitivities of these units are in general consistent with nociceptors, although the thermal thresholds differ. These data provide the first detailed report of response properties of intracranial primary afferent units, likely to be involved in transmission of nociception and possibly mediation of intracranial pain.
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Affiliation(s)
- G M Bove
- Department of Neurosurgery, Massachusetts General Hospital, USA
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42
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Kobari M, Tomita M, Tanahashi N, Yokoyama M, Takao M, Fukuuchi Y. Intravascular substance P dilates cerebral parenchymal vessels through a specific tachykinin NK1 receptor in cats. Eur J Pharmacol 1996; 317:269-74. [PMID: 8997610 DOI: 10.1016/s0014-2999(96)00725-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The role of substance P in the cerebral parenchymal circulation was examined in 19 anesthetized cats. The local cerebral blood volume in the temporoparietal cortex was measured by our photoelectric method. Cerebral blood volume reflects the cumulative dimensions of the parenchymal microvessels. Intravenous injection of 0.01, 0.1, and 1 mg/kg FK888 (N2-[(4R)-4-hydroxy-1-(1-methyl-1H-indol-3-yl) carbonyl-L-prolyl]-N-methyl-N-phenylmethyl-3-(2-naphthyl)-L-alaninamide) , a selective tachykinin NK1 receptor antagonist, had no significant effects (compared to the vehicle, ethanol) on cerebral blood volume and mean arterial blood pressure. Intracarotid injection of 1, 10, 100 pmol/kg, and 1 nmol/kg substance P increased cerebral blood volume (P < 0.01) in a dose-dependent manner (maximal increase of 6.5% at 5 min). Following injection of 1 nmol/kg substance P, cerebral blood volume was initially reduced, possibly due to the marked fall in mean arterial blood pressure (P < 0.01). The cerebral blood volume increase elicited by 1 nmol/kg substance P was strongly blocked (P < 0.05) by prior injection of 1 mg/kg FK888. However, the depressor effect of 1 nmol/kg substance P (-24 +/- 4 mm Hg at 30 s, P < 0.01) was partially inhibited (P < 0.01) by FK888. We conclude that endogenous substance P may not have a significant role in the maintenance of resting tone of cerebral parenchymal vessels. Intravascular substance P, however, dilates the small microvessels through a specific tachykinin NK1 receptor and could be involved in the development of pathologic processes such as migraine headache.
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Affiliation(s)
- M Kobari
- Department of Neurology, School of Medicine, Keio University, Tokyo, Japan
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43
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Umemura A, Yamada K. Contribution of cerebrovascular parasympathetic and sensory innervation to the development of cerebral edema in rat focal ischemia and reperfusion. Neurosci Lett 1996. [DOI: 10.1016/0304-3940(96)12950-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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44
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Perren MJ, Connor HE, Beattie DT. NK1 and CGRP receptor-mediated dilatation of the carotid arterial bed of the anaesthetized rabbit. Neuropeptides 1996; 30:141-8. [PMID: 8771556 DOI: 10.1016/s0143-4179(96)90081-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The present study has investigated the effects of alpha and beta calcitonin gene-related peptide (CGRP), and the tachykinin neurokinin1 (NK1) receptor agonist, substance P methyl ester (SPOMe), on carotid vascular resistance, following their injection into the carotid artery bed of the anaesthetized rabbit. The involvement of CGRP and NK1 receptors in nicotine-induced alterations in carotid vascular resistance has also been characterized. alpha-or beta CGRP (1 and 10 pmolkg-1 i.a.) and SPOMe (0.01 and 0.1 pmolkg-1 i.a.) caused dose-related increases in carotid arterial blood flow associated with decreases in carotid arterial vascular resistance with little effect on arterial blood pressure. The selective CGRP receptor antagonist, CGRP8-37 (0.34 mumolkg-1 i.v.), caused a rightward displacement of the dose-response curves to both alpha- and beta CGRP; mean dose-ratios, 5 min after antagonist administration, were 14 and 24 respectively. The selective NK1 receptor antagonist, CP99 994 (0.23 mumolkg-1 i.v.), caused a rightward shift in the dose-response curve to SPOMe; mean dose-ratios, 15 and 75 min after antagonist administration, were 42 and 16 respectively. CGRP8-37 (0.34 mumolkg-1) had no effect on decreases in carotid arterial vascular resistance produced by SPOMe, and CP99 994 (0.23 mumolkg-1 i.v.) had no effect on vasodilator responses produced by either alpha- or beta CGRP. Intracarotid injection of nicotine (0.002-2 mumolkg-1) caused dose-dependent transient, followed by a more prolonged, increase in carotid blood flow and reduction in arterial vascular resistance. The prolonged carotid vasodilator response produced by nicotine (0.2 mumolkg-1) was markedly attenuated by CGRP8-37 (0.34 mumolkg-1 i.v.) but unaffected by CP99 994 (1.15 mumolkg-1 i.v.) suggesting a role for CGRP, and not substance P, in this vasodilation. Neither receptor antagonist affected the transient response produced by nicotine. This study has demonstrated that intracarotid injection of NK1 and CGRP receptor agonists to the anaesthetized rabbit results in an increase in carotid blood flow and a reduction in vascular resistance, indicative of vasodilatation of this artery bed. CGRP mediates the nicotine-induced dilatation of the carotid vascular bed, consistent with its release from sensory nerves. This model should prove useful for the in vivo characterization of NK1 or CGRP receptor agonist and antagonist activities, and in the study of neurogenically induced vasodilation.
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Affiliation(s)
- M J Perren
- Glaxo Wellcome Medicines Research Centre, Stevenage, Hertfordshire, UK
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45
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Escott KJ, Connor HE, Brain SD, Beattie DT. The involvement of calcitonin gene-related peptide (CGRP) and substance P in feline pial artery diameter responses evoked by capsaicin. Neuropeptides 1995; 29:129-35. [PMID: 8538873 DOI: 10.1016/0143-4179(95)90014-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The effects of capsaicin and selective neuropeptide antagonists on pial artery diameter were measured using an on-line image analyser in anaesthetised cats, in order to monitor the effects of mediators released in response to activation of trigeminal nerves. Perivascular injection of CGRP (10(-8) M) and the neurokinin-1 (NK1) receptor agonist substance P methyl ester, SPOMe (10(-6) M) produced an increase in pial artery diameter. The vasodilatory action of these agonists was significantly and selectively inhibited using the CGRP receptor antagonist, CGRP8-37 (10(-6) M), and the NK1 receptor antagonist, CP99994 (10(-6) M) respectively. Capsaicin (10(-8)-10(-5) M) produced a biphasic response upon perivascular injection that was concentration dependent. At 10(-6) M capsaicin an initial transient vasoconstriction was observed followed by a longer-lasting vasodilatation. The vasodilator component was significantly reduced by CGRP8-37 (10(-6) M) or CP99994 (10(-6) M). These results show that chemical (capsaicin) activation of trigeminal nerves leads to vasodilatation of feline arteries in situ. This vasodilatation is mediated via the activation of CGRP and NK1 receptors probably via the efferent release of CGRP and a substance P-like peptide.
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Affiliation(s)
- K J Escott
- Pharmacology Group, King's College, London, UK
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46
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Cutrer FM, Moussaoui S, Garret C, Moskowitz MA. The non-peptide neurokinin-1 antagonist, RPR 100893, decreases c-fos expression in trigeminal nucleus caudalis following noxious chemical meningeal stimulation. Neuroscience 1995; 64:741-50. [PMID: 7536309 DOI: 10.1016/0306-4522(94)00428-8] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The effect of RPR 100893, a selective and specific neurokinin-1 antagonist, or its enantiomer RPR 103253 was examined on c-fos antigen expression in brain stem and upper cervical cord 2 h after intracisternal capsaicin injection (30.5 micrograms/ml) in pentobarbital-anesthetized Hartley guinea-pigs. Positive cells were counted at three levels corresponding to obex, -2.25 mm and -6.75 mm in 18 sections (50 microns). Immunoreactivity was strongly expressed within laminae I and IIo of trigeminal nucleus caudalis, area postrema and the leptomeninges. Moderate labeling was present in the nucleus of the solitary tract and the medullary lateral reticular nucleus, whereas few positive cells were found in the ventral portion of the medullary reticular nucleus and Rexed laminae III-V and X. The distribution of labeled cells was consistent with previously reported results following subarachnoid placement of the noxious agents, blood or carrageenin. Pretreatment with RPR 100893 (1, 10 and 100 micrograms/kg, i.v.) but not its enantiomer (100 micrograms/kg, i.v.) 30 min prior to capsaicin injection significantly reduced the number of positive cells in the trigeminal nucleus caudalis (P < 0.01) in a dose-dependent manner, but not within area postrema or nucleus of the solitary tract. These results indicate that (i) the instillation of capsaicin into the subarachnoid space is an effective stimulus for the induction of c-fos antigen within trigeminal nucleus caudalis, presumably through activation of trigeminovascular afferents, and (ii) the neurokinin-1 antagonist RPR 100893 reduces the number of positive cells selectively within this nucleus. The findings are significant because drugs which alleviate vascular headaches decrease the number of c-fos-positive cells within trigeminal nucleus caudalis following noxious meningeal stimulation. Hence, strategies aimed at blocking the neurokinin-1 receptor may be useful for treating migraine and cluster headache.
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Affiliation(s)
- F M Cutrer
- Stroke Research Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston 02114, USA
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47
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Ando K, Ishikawa A, Okura N. Nature and origin of cerebrovascular nerves with substance P immunoreactivity in bats (Mammalia: Microchiroptera), with special reference to species differences. J Comp Neurol 1994; 347:357-68. [PMID: 7529774 DOI: 10.1002/cne.903470304] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Double staining immunohistochemistry was used to investigate the origin and projection of nerves with substance P (SP) immunoreactivity (-IR) in the walls of the major cerebral arteries in two microchiropteran species. In the greater horseshoe bat, most of the cerebral perivascular nerves with SP-IR did not exhibit calcitonin gene-related peptide (CGRP)-IR, but emitted bright immunofluorescence for vasoactive intestinal polypeptide (VIP). In this species, a large number of cell bodies with both SP- and VIP-IR were observed in many cranial ganglia along various branches of the facial and glossopharyngeal nerves. There were no cell bodies immunoreactive for either SP and VIP in the two sensory (trigeminal and upper cervical dorsal root), two sympathetic (superior cervical and stellate), or two vagal (superior and jugular) ganglia. In addition, several thick fiber bundles with both SP- and VIP-IR were present in the wall of the cerebral carotid artery, and descended progressively reaching as far as the middle part of the basilar artery (BA). These and other findings suggest that SP-immunoreactive nerves with VIP-IR but not CGRP-IR, which contribute to the rich innervation of the vertebrobasilar system in the greater horseshoe bat, originate from neurons with the same combination of peptide-IR in the major or local facial or glossopharyngeal parasympathetic ganglia, and enter the cranial cavity along the internal carotid artery. In the bent-winged bat, however, cerebral perivascular SP-immunoreactive nerves, as well as SP-immunoreactive neurons within the trigeminal and upper cervical dorsal root ganglia (uCDRG), showed neither CGRP-IR nor VIP-IR, and were mostly confined to the caudal BA and the vertebral artery (VA). These observations, in addition to the projection of this nerve type to the BA via the VA as fiber bundles, or through the meninges, indicate that the principal source of the cerebrovascular SP-immunoreactive innervation in this species is the uCDRG.
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Affiliation(s)
- K Ando
- Department of Regional Culture, Faculty of International Studies of Culture, Kyushu Sangyo University, Fukuoka, Japan
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48
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Zhang QJ, Kobayashi S, Hongo K. Trigeminal sensory innervation on perforators of the circle of Willis in rabbits by wheat germ agglutinin-conjugated horseradish peroxidase anterograde tracing. JOURNAL OF THE AUTONOMIC NERVOUS SYSTEM 1994; 48:199-205. [PMID: 7525685 DOI: 10.1016/0165-1838(94)90048-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Distribution patterns of sensory innervation from the trigeminal ganglion to the perforators of the circle of Willis in rabbits were investigated by wheat germ agglutinin-conjugated horseradish peroxidase (WGA-HRP) anterograde tracing. Twenty Japanese white rabbits were anesthetized by inhaling 1% halothane. Using a microsurgical technique, 4 microliters of 2% WGA-HRP in 1 M KCl solution, colored with brilliant blue, was micro-injected into the medial part of the left trigeminal ganglion in 14 animals with a pressure injection system. Another six served as controls to exclude the possibility of labeling non-trigeminal axons. Forty-eight hours later, the perforators in the cisternal and intracerebral segments along with their parent arteries were dissected from the brain according to Dacey's dissecting technique after transcardial perfusion, reacted with the 3,3',5,5'-tetramethyl benzidine method of Mesulam. The results revealed that sensory nerves on the perforators of the circle of Willis were less densely innervated than those on their parent arteries due to the difference in diameter. The posteromedial perforating arteries arising from the P1 segment of the posterior cerebral artery to the tegmentum, posteroventral thalamus and posterior hypothalamus were more prominently and consistently innervated than other perforators. The sensory fibers were seen on the cisternal segment of the perforating arteries. A parallel or twisted pattern was found in the perforators less than 100 microns in diameter, while a meshwork pattern was visualized in the proximal part of some bigger ones. Fine sensory fibers could be traced on the perforators as small as 40 microns in diameter.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- Q J Zhang
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan
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49
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Lee WS, Moussaoui SM, Moskowitz MA. Blockade by oral or parenteral RPR 100893 (a non-peptide NK1 receptor antagonist) of neurogenic plasma protein extravasation within guinea-pig dura mater and conjunctiva. Br J Pharmacol 1994; 112:920-4. [PMID: 7921621 PMCID: PMC1910223 DOI: 10.1111/j.1476-5381.1994.tb13168.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
1. The ability of an NK1 receptor antagonist, RPR 100893, and its enantiomer, RPR 103253 to block neurogenic plasma protein extravasation in guinea-pig dura mater and conjunctiva was assessed following 125I-labelled bovine serum albumin ([125I]-BSA, 50 muCi kg-1, i.v.) and unilateral electrical stimulation of the trigeminal ganglion (0.6 mA, 5 ms, 5 Hz, 5 min) or capsaicin administration (150 micrograms kg-1, i.v.). 2. When administered p.o. 60 min prior to electrical stimulation, RPR 100893 (> or = 0.1 microgram kg-1) decreased plasma protein extravasation in dura mater in a dose-dependent manner, whereas the enantiomer (10 or 100 micrograms kg-1, p.o.) was inactive. 3. When given i.v. 30 min prior to electrical stimulation, RPR 100893 (> or = 0.5 ng kg-1) significantly inhibited plasma protein extravasation in the dura mater evoked by electrical stimulation in a dose-dependent manner. 4. RPR 100893 (100 micrograms kg-1, p.o.) also reduced the leakage when given 45 min before the guinea-pigs were killed and 10, 40 and 80 min after electrical trigeminal stimulation. 5. RPR 100893 given p.o. dose-dependently inhibited capsaicin-induced plasma protein extravasation with ID50S of 7.4 micrograms kg-1 and 82 micrograms kg-1 for dura mater and conjunctiva, respectively. 6. These results are consistent with the contention that NK1 receptors mediate neurogenic plasma protein leakage following trigeminal stimulation, and suggest that NK1 receptor antagonists of the perhydroisoindolone series may be useful for treating migraine and cluster headaches.
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Affiliation(s)
- W S Lee
- Stroke Research Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston 02114
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50
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Robertson D, Kincaid DW, Haile V, Robertson RM. The head and neck discomfort of autonomic failure: an unrecognized aetiology of headache. Clin Auton Res 1994; 4:99-103. [PMID: 7994169 DOI: 10.1007/bf01845772] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Information concerning the frequency, severity, character, location, duration, diurnal pattern of headache and ancillary symptoms were obtained in 25 patients with autonomic failure and 44 control subjects. Precipitating and ameliorating factors were identified. Autonomic failure patients had more head and neck discomfort than controls. Their discomfort was much more likely to localize in the occiput, nape of the neck and shoulder, compared with controls. There was a greater tendency for the discomfort to occur in the morning and after meals. It was sometimes less than 5 min in duration and was often associated with dimming, blurring, or tunnelling of vision. It was provoked by upright posture and relieved by lying down. Patients with severe autonomic failure and orthostatic hypotension often present with a posture-dependent headache or neck pain. Because the relationship of these symptoms to posture is often not recognized, the fact that these findings may signal an underlying autonomic disorder is underappreciated, and the opportunity to consider this aetiology for the headache may be missed.
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Affiliation(s)
- D Robertson
- Department of Medicine, Vanderbilt University, Nashville, TN 37232-2195
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