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Hasırcı Bayır BR, Aksu S, Gezegen H, Karaaslan Z, Yüceer H, Cerrahoğlu Şirin T, Küçükali Cİ, Kurt A, Karamürsel S, Yılmaz V, Baykan B. Effects of Transcranial Direct Current Stimulation on Clinical Outcomes, Calcitonin Gene-Related Peptide, and Pituitary Adenylate Cyclase-Activating Polypeptide-38 Levels in Menstrual Migraine. Neuromodulation 2024; 27:835-846. [PMID: 38506767 DOI: 10.1016/j.neurom.2024.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 12/27/2023] [Accepted: 01/29/2024] [Indexed: 03/21/2024]
Abstract
OBJECTIVES Transcranial direct current stimulation (tDCS) has been suggested as an alternative treatment option for migraine. The present study aimed to evaluate the efficacy of tDCS on clinical outcomes in addition to calcitonin gene-related peptide (CGRP) and pituitary adenylate cyclase-activating peptide 38 (PACAP-38) levels in individuals with menstrual-related migraine (MRM) for the first time. MATERIALS AND METHODS In this parallel study, 58 female patients between the ages of 18 and 45 years, including 36 with MRM and 22 with nonmenstrual migraines (nMM), were recruited. Sessions of 2-mA 20-minute anodal tDCS were administered over the left dorsolateral prefrontal cortex within three consecutive days (1:1 active and sham stimulation). Migraine attack frequency, severity, analgesic usage, CGRP, and PACAP-38 levels of the patients were evaluated before and one month after tDCS. RESULTS After tDCS, in the active group compared with the sham group, the frequency (p = 0.031), the severity of attacks (p = 0.003), the number of days with headache (p = 0.004), and the analgesic usage (p = 0.024) were all decreased. In both MRM and nMM groups, the frequency and severity of attacks and analgesic usage were decreased in those receiving active stimulation (p < 0.001 for each). CGRP and PACAP-38 levels were no different in the active group and the sham group after tDCS. CONCLUSIONS tDCS was shown to be efficacious in migraine prophylaxis and a valuable option for migraine and MRM treatment. The absence of changes in serum CGRP and PACAP-38 levels suggests that tDCS efficacy may stem from distinct cerebral electrophysiological mechanisms.
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Affiliation(s)
- Buse Rahime Hasırcı Bayır
- Haydarpaşa Numune Reasearch and Training Hospital, Istanbul, Turkey; Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
| | - Serkan Aksu
- Department of Physiology, Muğla Sıtkı Koçman University, Muğla, Turkey; Department of Physiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Haşim Gezegen
- Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Zerrin Karaaslan
- Department of Neuroscience, Aziz Sancar Institute of Experimental Medicine, Istanbul University, Istanbul, Turkey
| | - Hande Yüceer
- Department of Neuroscience, Aziz Sancar Institute of Experimental Medicine, Istanbul University, Istanbul, Turkey
| | - Tuba Cerrahoğlu Şirin
- Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey; Şişli Etfal Research and Training Hospital, Istanbul, Turkey
| | - Cem İsmail Küçükali
- Department of Neuroscience, Aziz Sancar Institute of Experimental Medicine, Istanbul University, Istanbul, Turkey
| | - Adnan Kurt
- Department of Physiology, School of Medicine, Koç University, Istanbul, Turkey
| | - Sacit Karamürsel
- Department of Physiology, School of Medicine, Koç University, Istanbul, Turkey
| | - Vuslat Yılmaz
- Department of Neuroscience, Aziz Sancar Institute of Experimental Medicine, Istanbul University, Istanbul, Turkey
| | - Betül Baykan
- Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey; Department of Neuroscience, Aziz Sancar Institute of Experimental Medicine, Istanbul University, Istanbul, Turkey
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de Vries T, Boucherie DM, Chan KY, Rubio-Beltrán E, Labastida-Ramírez A, Labruijere S, Gupta S, van den Bogaerdt A, Vincent A, Dammers R, Danser AHJ, MaassenVanDenBrink A. Sex differences in CGRP-induced vasodilation of human middle meningeal arteries but not human coronary arteries: implications for migraine. Cephalalgia 2024; 44:3331024241254088. [PMID: 39043230 DOI: 10.1177/03331024241254088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/25/2024]
Abstract
BACKGROUND Migraine prevalence and levels of calcitonin gene-related peptide (CGRP), a peptide involved in migraine pathophysiology, differ between men and women, and appear to be affected by changes in sex hormones. The present study investigated the sex-specific responses to CGRP in human isolated arteries. METHODS CGRP-induced relaxation of 62 (28 men and 34 women) human isolated middle meningeal arteries (HMMA) and 139 (69 men and 70 women) human isolated coronary arteries (HCA) was compared between men and women in groups <50 years and ≥50 years of age as a proxy for pre- and postmenopausal status in women, as well as matched-age groups for men. RESULTS In HCA, no differences were observed between male and female tissue, or between the different age groups. However, in HMMA, the maximum response was significantly smaller and CGRP was less potent in females <50 compared with males <50 years of age. No differences were observed between the older age groups. CONCLUSIONS Sex differences were observed for CGRP-induced relaxation of HMMA, but not HCA. These differences could arise from differential receptor expression in the vascular beds combined with the effect of sex hormones on CGRP and subsequent receptor desensitization.
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Affiliation(s)
- Tessa de Vries
- Division of Vascular Medicine and Pharmacology, Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, The Netherlands
| | - Deirdre M Boucherie
- Division of Vascular Medicine and Pharmacology, Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, The Netherlands
| | - Kayi Y Chan
- Division of Vascular Medicine and Pharmacology, Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, The Netherlands
| | - Eloísa Rubio-Beltrán
- Division of Vascular Medicine and Pharmacology, Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, The Netherlands
| | - Alejandro Labastida-Ramírez
- Division of Vascular Medicine and Pharmacology, Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, The Netherlands
| | - Sieneke Labruijere
- Division of Vascular Medicine and Pharmacology, Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, The Netherlands
| | - Saurabh Gupta
- Division of Vascular Medicine and Pharmacology, Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, The Netherlands
| | | | - Arnaud Vincent
- Department of Neurosurgery, Erasmus MC, University Medical Center Rotterdam, The Netherlands
| | - Ruben Dammers
- Department of Neurosurgery, Erasmus MC, University Medical Center Rotterdam, The Netherlands
| | - A H Jan Danser
- Division of Vascular Medicine and Pharmacology, Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, The Netherlands
| | - Antoinette MaassenVanDenBrink
- Division of Vascular Medicine and Pharmacology, Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, The Netherlands
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Rahman SM, Hauser C, Luebke AE. Loss of calcitonin gene-related peptide (αCGRP) and use of a vestibular challenge highlight balance deficiencies in aging mice. PLoS One 2024; 19:e0303801. [PMID: 38865379 PMCID: PMC11168652 DOI: 10.1371/journal.pone.0303801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 04/30/2024] [Indexed: 06/14/2024] Open
Abstract
Aging impacts the vestibular system and contributes to imbalance. In fact, imbalance precedes changes in cognition in the elderly. However, research is limited in assessing aging mouse models that are deficient in crucial neuromodulators like Calcitonin Gene-Related Peptide (CGRP). We studied the loss of CGRP and its effects in the aging mouse, namely its effect on both static and dynamic imbalances. Postural sway and rotarod testing were performed before and after a vestibular challenge (VC) in the 129S wild type and the αCGRP (-/-) null mice. Four age groups were tested that correspond to young adulthood, late adulthood, middle age, and senescence in humans. Our results suggest wild type mice experience a decline in rotarod ability due to aging after they reach their prime performance at 6-10 months of age, while the αCGRP (-/-) null mice perform poorly on rotarod early in life but improve with age as they get older, potentially due to vestibular compensation. Our postural sway study suggests that a vestibular challenge can lead to significantly reduced CoP ellipse areas (freezing behaviors) in older mice, and this change occurs earlier in the αCGRP (-/-) null but requires future studies to evaluate anxiety effects. These results indicate that αCGRP is an important component of proper balance and that the loss of αCGRP can contribute to balance complications that may compound with aging.
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Affiliation(s)
- Shafaqat M. Rahman
- Department of Biomedical Engineering, University of Rochester, Rochester, NY, United States of America
| | - Catherine Hauser
- Department of Biomedical Engineering, University of Rochester, Rochester, NY, United States of America
| | - Anne E. Luebke
- Department of Biomedical Engineering, University of Rochester, Rochester, NY, United States of America
- Department of Neuroscience, Del Monte Institute of Neuroscience, University of Rochester Medical Center, Rochester, NY, United States of America
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Storch E, Overeem LH, Terhart M, Fitzek MP, Lange KS, Reuter U, Raffaelli B. PACAP-38 and sex hormones in women with migraine: exploratory analysis of a cross-sectional, matched cohort study. J Headache Pain 2024; 25:98. [PMID: 38858641 PMCID: PMC11165852 DOI: 10.1186/s10194-024-01804-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 06/04/2024] [Indexed: 06/12/2024] Open
Abstract
BACKGROUND Endogeneous and exogeneous sex hormones can impact the frequency and severity of migraine attacks, but the underlying mechanisms are poorly understood. In this study, we investigate the relationship between female sex hormones and Pituitary Adenylate Cyclase-Activating Polypeptide-38 (PACAP-38) concentrations in plasma of women with migraine and healthy controls, aiming to elucidate potential hormonal influences on PACAP dynamics and their relevance to migraine pathophysiology. METHODS This analysis is part of a cross-sectional, matched-cohort study. We recruited two groups of women with episodic migraine: one with a regular menstrual cycle (M-RMC) and another undergoing combined oral contraceptive treatment (M-COC). Additionally, we included corresponding age-matched control groups without migraine for both categories (C-RMC and C-COC). For participants with a RMC, the study visits were scheduled during the perimenstrual period (menstrual cycle day 2 ± 2) and periovulatory period (day 13 ± 2). Participants using COC were examined at day 4 ± 2 of the hormone-free interval and between day 7-14 of the hormone intake phase. During these visits, PACAP-38 concentrations in plasma were measured using a commercial Enzyme-linked-immunosorbent assay (ELISA) kit. RESULTS The study included 120 women, with 30 participants in each group. Women with migraine and a RMC had significantly higher PACAP-38 plasma concentrations compared to healthy controls at both study visits [day 2 ± 2: M-RMC: 2547.41 pg/ml (IQR 814.27 - 4473.48) vs. C-RMC: 1129.49 pg/ml (IQR 257.34 - 2684.88), p = 0.025; day 13 ± 2: M-RMC: 3098.89 pg/ml (IQR 1186.29 - 4379.47) vs. C-RMC: 1626.89 (IQR 383.83 - 3038.36), p = 0.028]. In contrast, PACAP-38 levels were comparable between migraine and control groups receiving COC. Women with migraine and a RMC exhibited higher PACAP-38 concentrations during menstruation compared to those using COC during the hormone-free interval. CONCLUSION Systemic PACAP-38 concentrations in women vary based on the presence of migraine diagnosis and their hormonal status.
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Affiliation(s)
- Elisabeth Storch
- Department of Neurology, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Charitéplatz 1, Berlin, 10117, Germany
| | - Lucas H Overeem
- Department of Neurology, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Charitéplatz 1, Berlin, 10117, Germany
| | - Maria Terhart
- Department of Neurology, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Charitéplatz 1, Berlin, 10117, Germany
| | - Mira P Fitzek
- Department of Neurology, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Charitéplatz 1, Berlin, 10117, Germany
| | - Kristin S Lange
- Department of Neurology, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Charitéplatz 1, Berlin, 10117, Germany
- Clinician Scientist Program, Berlin Institute of Health at Charité (BIH), Berlin, Germany
| | - Uwe Reuter
- Department of Neurology, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Charitéplatz 1, Berlin, 10117, Germany
- Universitätsmedizin Greifswald, Greifswald, Germany
| | - Bianca Raffaelli
- Department of Neurology, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Charitéplatz 1, Berlin, 10117, Germany.
- Clinician Scientist Program, Berlin Institute of Health at Charité (BIH), Berlin, Germany.
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Li C, Ajmal E, Alok K, Powell K, Wadolowski S, Tambo W, Turpin J, Barthélemy E, Al-Abed Y, LeDoux D. CGRP as a potential mediator for the sexually dimorphic responses to traumatic brain injury. Biol Sex Differ 2024; 15:44. [PMID: 38816868 PMCID: PMC11138127 DOI: 10.1186/s13293-024-00619-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 05/15/2024] [Indexed: 06/01/2024] Open
Abstract
BACKGROUND The outcomes of traumatic brain injury (TBI) exhibit variance contingent upon biological sex. Although female sex hormones exert neuroprotective effects, the administration of estrogen and progesterone has not yielded conclusive results. Hence, it is conceivable that additional mediators, distinct from female sex hormones, merit consideration due to their potential differential impact on TBI outcomes. Calcitonin gene-related peptide (CGRP) exhibits sexually dimorphic expression and demonstrates neuroprotective effects in acute brain injuries. In this study, we aimed to examine sex-based variations in TBI structural and functional outcomes with respect to CGRP expression. METHODS Male and female Sprague Dawley rats were exposed to controlled cortical impact to induce severe TBI, followed by interventions with and without CGRP inhibition. In the acute phase of TBI, the study centered on elucidating the influence of CGRP on oxidative stress, nuclear factor erythroid 2-related factor 2 (Nrf2) and endothelial nitric oxide synthase (eNOS) signaling in the peri-impact tissue. Subsequently, during the chronic phase of TBI, the investigation expanded to evaluate CGRP expression in relation to lesion volume, microvascular dysfunction, and white matter injury, as well as working and spatial memory, anxiety-like, and depression-like behaviors in subjects of both sexes. RESULTS Female rats exhibited elevated levels of CGRP in the peri-impact brain tissue during both baseline conditions and in the acute and chronic phases of TBI, in comparison to age-matched male counterparts. Enhanced CGRP levels in specific brain sub-regions among female rats correlated with superior structural and functional outcomes following TBI compared to their male counterparts. CGRP inhibition induced heightened oxidative stress and a reduction in the expression of Nrf2 and eNOS in both male and female rats, with the observed alteration being more pronounced in females than in males. CONCLUSIONS This study marks the inaugural identification of CGRP as a downstream mediator contributing to the sexually dimorphic response observed in TBI outcomes.
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Affiliation(s)
- Chunyan Li
- Translational Brain Research Laboratory, The Feinstein Institutes for Medical Research, 350 Community Dr, Manhasset, NY, 11030, USA.
- Department of Neurosurgery, North Shore University Hospital, Manhasset, NY, 11030, USA.
- Elmezzi Graduate School of Molecular Medicine at Northwell Health, Manhasset, NY, 11030, USA.
- Institute of Bioelectronic Medicine, The Feinstein Institutes for Medical Research, Manhasset, NY, 11030, USA.
| | - Erum Ajmal
- Translational Brain Research Laboratory, The Feinstein Institutes for Medical Research, 350 Community Dr, Manhasset, NY, 11030, USA
- Division of Neurosurgery, SUNY Downstate College of Medicine, Brooklyn, NY, 11203, USA
| | - Khaled Alok
- Department of Neurosurgery, North Shore University Hospital, Manhasset, NY, 11030, USA
| | - Keren Powell
- Translational Brain Research Laboratory, The Feinstein Institutes for Medical Research, 350 Community Dr, Manhasset, NY, 11030, USA
- Institute of Bioelectronic Medicine, The Feinstein Institutes for Medical Research, Manhasset, NY, 11030, USA
| | - Steven Wadolowski
- Translational Brain Research Laboratory, The Feinstein Institutes for Medical Research, 350 Community Dr, Manhasset, NY, 11030, USA
- Institute of Bioelectronic Medicine, The Feinstein Institutes for Medical Research, Manhasset, NY, 11030, USA
| | - Willians Tambo
- Translational Brain Research Laboratory, The Feinstein Institutes for Medical Research, 350 Community Dr, Manhasset, NY, 11030, USA
- Elmezzi Graduate School of Molecular Medicine at Northwell Health, Manhasset, NY, 11030, USA
- Institute of Bioelectronic Medicine, The Feinstein Institutes for Medical Research, Manhasset, NY, 11030, USA
| | - Justin Turpin
- Department of Neurosurgery, North Shore University Hospital, Manhasset, NY, 11030, USA
| | - Ernest Barthélemy
- Division of Neurosurgery, SUNY Downstate College of Medicine, Brooklyn, NY, 11203, USA
| | - Yousef Al-Abed
- Institute of Bioelectronic Medicine, The Feinstein Institutes for Medical Research, Manhasset, NY, 11030, USA
| | - David LeDoux
- Department of Neurosurgery, North Shore University Hospital, Manhasset, NY, 11030, USA
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Eggertsen PP, Palmfeldt J, Schytz HW, Hay D, Olsen RKJ, Nielsen JF. Serum calcitonin gene-related peptide in patients with persistent post-concussion symptoms, including headache: a cohort study. J Neurol 2024; 271:2458-2472. [PMID: 38231270 PMCID: PMC11055722 DOI: 10.1007/s00415-024-12181-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 12/28/2023] [Accepted: 12/29/2023] [Indexed: 01/18/2024]
Abstract
BACKGROUND Calcitonin gene-related peptide (CGRP) plays an important role in migraine pathophysiology, and post-traumatic headache (PTH) frequently presents with migraine-like features. Despite several clinical similarities, few studies have explored CGRP in PTH and concussion. This study investigates serum CGRP levels in patients with persistent post-concussion symptoms (PPCS), including PTH. METHODS This cohort study was based on serum samples from individuals aged 18-30 years with PPCS who participated in a previously published randomized controlled trial of a non-pharmacological intervention. The primary outcome was serum CGRP concentrations, determined at baseline before randomization and at follow-up 7 months later, using an enzyme-linked immunosorbent assay (ELISA). CGRP levels at baseline were compared with healthy anonymous blood donors in the same age group. RESULTS Baseline serum samples were collected from 86 participants with PPCS. The participants were most often female (78%) and migraine-like headache was the most frequent headache phenotype (74%). Serum CGRP levels were higher in participants with PPCS than in 120 healthy individuals (median: 158.5 pg/mL vs. 76.3 pg/mL, p = 0.050). A stratified analysis revealed that females with PPCS had a fivefold higher median than healthy females (166.3 pg/mL vs. 32.1 pg/mL, p = 0.0006), while no differences were observed in males (p = 0.83). At follow-up, CGRP levels decreased with a median change of - 1.3 pg/mL (95% confidence interval: - 17.6-0, p = 0.024). DISCUSSION Elevated serum levels of CGRP in patients with PPCS and a decrease over time suggest an involvement of CGRP in PTH/PPCS. If confirmed in other studies, it could pave the way for CGRP-targeted therapies, which could have clinical significance.
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Affiliation(s)
- Peter Preben Eggertsen
- Department of Clinical Medicine, Hammel Neurorehabilitation Centre and University Research Clinic, Aarhus University, Voldbyvej 15A, 8450, Hammel, Denmark.
- Department of Clinical Medicine, Research Unit for Molecular Medicine, Aarhus University Hospital and Aarhus University, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark.
| | - Johan Palmfeldt
- Department of Clinical Medicine, Research Unit for Molecular Medicine, Aarhus University Hospital and Aarhus University, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
| | - Henrik Winther Schytz
- Faculty of Health and Medical Sciences, Department of Neurology, Danish Headache Center, Rigshospitalet Glostrup, University of Copenhagen, Valdemar Hansens Vej 5, 2600, Glostrup, Denmark
| | - Debbie Hay
- Department of Pharmacology and Toxicology, University of Otago, 362 Leith Street, Dunedin North, Dunedin, 9016, New Zealand
| | - Rikke Katrine Jentoft Olsen
- Department of Clinical Medicine, Research Unit for Molecular Medicine, Aarhus University Hospital and Aarhus University, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
| | - Jørgen Feldbæk Nielsen
- Department of Clinical Medicine, Hammel Neurorehabilitation Centre and University Research Clinic, Aarhus University, Voldbyvej 15A, 8450, Hammel, Denmark
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Galiniak S, Biesiadecki M, Rościszewska-Żukowska I, Rachel M. Calcitonin Gene-Related Peptide Level in Cystic Fibrosis Patients. Life (Basel) 2024; 14:565. [PMID: 38792587 PMCID: PMC11122201 DOI: 10.3390/life14050565] [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: 03/17/2024] [Revised: 04/22/2024] [Accepted: 04/26/2024] [Indexed: 05/26/2024] Open
Abstract
Calcitonin gene-related peptide (CGRP) has long been implicated in both the physiology and pathophysiology of the respiratory tract. The objective of our study was to determine the serum concentration of alpha CGRP (αCGRP) in cystic fibrosis (CF) that arises from mutations in the gene responsible for encoding the cystic fibrosis transmembrane conductance regulator (CFTR) protein. Currently, there are not many data in the literature about the role of CGRP in CF. The serum level of αCGRP was estimated using the enzyme-linked immunosorbent assay among 64 patients with CF and 31 healthy controls. The αCGRP concentration in the CF group was 62.51 ± 15.45 pg/mL, while in the control group it was 47.43 ± 8.06 pg/mL (p < 0.001). We also compared the level of αCGRP in CF patients according to the type of CFTR mutation. Homozygotes for ΔF508 had higher αCGRP levels than heterozygotes (67.9 ± 10.2 vs. 54.5 ± 18.3 pg/mL, p < 0.01). The level of this neuropeptide was statistically higher in patients with severe disease than in those with mild CF (p = 0.003) when patients were divided into three groups by spirometry results. αCGRP concentration was not correlated with age, sex, clinical parameters, and pulmonary function test results in the study participants. The results of our study suggest a significant increase in the concentration of αCGRP in the serum of patients with CF compared to the control group. This observation opens interesting possibilities for understanding the role of αCGRP in the context of CF pathophysiology.
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Affiliation(s)
- Sabina Galiniak
- Institute of Medical Sciences, Medical College, Rzeszów University, Warzywna 1a, 35-310 Rzeszów, Poland; (M.B.); (I.R.-Ż.); (M.R.)
| | - Marek Biesiadecki
- Institute of Medical Sciences, Medical College, Rzeszów University, Warzywna 1a, 35-310 Rzeszów, Poland; (M.B.); (I.R.-Ż.); (M.R.)
| | - Iwona Rościszewska-Żukowska
- Institute of Medical Sciences, Medical College, Rzeszów University, Warzywna 1a, 35-310 Rzeszów, Poland; (M.B.); (I.R.-Ż.); (M.R.)
| | - Marta Rachel
- Institute of Medical Sciences, Medical College, Rzeszów University, Warzywna 1a, 35-310 Rzeszów, Poland; (M.B.); (I.R.-Ż.); (M.R.)
- Department of Allergology and Cystic Fibrosis, State Hospital 2 in Rzeszow, Lwowska 60, 35-301 Rzeszów, Poland
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Singh S, Kopruszinski CM, Watanabe M, Dodick DW, Navratilova E, Porreca F. Female-selective mechanisms promoting migraine. J Headache Pain 2024; 25:63. [PMID: 38658853 PMCID: PMC11040950 DOI: 10.1186/s10194-024-01771-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Accepted: 04/15/2024] [Indexed: 04/26/2024] Open
Abstract
Sexual dimorphism has been revealed for many neurological disorders including chronic pain. Prelicinal studies and post-mortem analyses from male and female human donors reveal sexual dimorphism of nociceptors at transcript, protein and functional levels suggesting different mechanisms that may promote pain in men and women. Migraine is a common female-prevalent neurological disorder that is characterized by painful and debilitating headache. Prolactin is a neurohormone that circulates at higher levels in females and that has been implicated clinically in migraine. Prolactin sensitizes sensory neurons from female mice, non-human primates and humans revealing a female-selective pain mechanism that is conserved evolutionarily and likely translationally relevant. Prolactin produces female-selective migraine-like pain behaviors in rodents and enhances the release of calcitonin gene-related peptide (CGRP), a neurotransmitter that is causal in promoting migraine in many patients. CGRP, like prolactin, produces female-selective migraine-like pain behaviors. Consistent with these observations, publicly available clinical data indicate that small molecule CGRP-receptor antagonists are preferentially effective in treatment of acute migraine therapy in women. Collectively, these observations support the conclusion of qualitative sex differences promoting migraine pain providing the opportunity to tailor therapies based on patient sex for improved outcomes. Additionally, patient sex should be considered in design of clinical trials for migraine as well as for pain and reassessment of past trials may be warranted.
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Affiliation(s)
- Shagun Singh
- Banner - University Medicine Sunrise Primary Care, Tucson, AZ, 85750, USA
| | - Caroline M Kopruszinski
- Department of Pharmacology, College of Medicine, University of Arizona, Tucson, AZ, 85724, USA
| | - Moe Watanabe
- Department of Pharmacology, College of Medicine, University of Arizona, Tucson, AZ, 85724, USA
| | - David W Dodick
- Department of Neurology, Mayo Clinic, Phoenix, AZ, USA
- Atria Academy of Science and Medicine, New York, NY, USA
| | - Edita Navratilova
- Department of Pharmacology, College of Medicine, University of Arizona, Tucson, AZ, 85724, USA
- Department of Neurology, Mayo Clinic, Phoenix, AZ, USA
| | - Frank Porreca
- Department of Pharmacology, College of Medicine, University of Arizona, Tucson, AZ, 85724, USA.
- Department of Neurology, Mayo Clinic, Phoenix, AZ, USA.
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Porreca F, Navratilova E, Hirman J, van den Brink AM, Lipton RB, Dodick DW. Evaluation of outcomes of calcitonin gene-related peptide (CGRP)-targeting therapies for acute and preventive migraine treatment based on patient sex. Cephalalgia 2024; 44:3331024241238153. [PMID: 38477313 DOI: 10.1177/03331024241238153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2024]
Abstract
BACKGROUND Women show increased prevalence and severity of migraine compared to men. Whether small molecule calcitonin gene-related peptide receptor (CGRP-R) antagonists (i.e., gepants) and monoclonal antibodies targeting either the CGRP-R or the CGRP peptide might show sexually dimorphic outcomes for acute and preventive therapy has not been established. METHODS We conducted a subpopulation analysis of available published data from FDA reviews to evaluate potential sex differences in the response rates of ubrogepant, rimegepant and zavegepant for acute migraine therapy. Available data from FDA reviews of erenumab, fremanezumab, galcanezumab and eptinezumab, approved CGRP-R and CGRP monoclonal antibodies and of atogepant were examined for prevention outcomes based on patient sex. Preventive outcomes were analyzed separately for patients with episodic migraine and chronic migraine. RESULTS In women, the three approved gepants produced statistically significant drug effects regardless of dose tested on the FDA mandated co-primary endpoints, the proportion of patients achieving two-hour pain-freedom and the proportion of patients free of their most bothersome symptom at two hours post-dose. In women, the average placebo-subtracted two-hour pain-freedom proportion was 9.5% (CI: 7.4 to 11.6) and the average numbers needed to treat was 11. The free from most bothersome symptom at two hours outcomes were also significant in women. The gepant drugs did not reach statistically significant effects on the two-hour pain-freedom endpoint in the men, with an average drug effect of 2.8% (CI: -2.5 to 8.2) and an average number needed to treat of 36. For freedom from most bothersome symptom at two hours post-dose endpoint, differences were not significant in male patients. The treatment effect in each of the gepant studies was always numerically greater in women than in men. In evaluation of prevention outcomes with the antibodies or atogepant using the change from the specified primary endpoint (e.g., monthly migraine days), the observed treatment effect for episodic migraine patients almost always favored drug over placebo in both women and men. For chronic migraine patients the treatment effects of antibodies were similar in men and women and always favored the drug treated group.Conclusion/Interpretation: Small molecule CGRP-R antagonists are effective in acute migraine therapy in women but available data do not demonstrate effectiveness in men. CGRP-targeting therapies are effective for migraine prevention in both male and female episodic migraine patients but possible sex differences remain uncertain. In male and female chronic migraine patients, CGRP/CGRP-R antibodies were similarly effective. The data highlight possible differential effects of CGRP targeted therapies in different patient populations and the need for increased understanding of CGRP neurobiology in men and women.
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Affiliation(s)
- Frank Porreca
- Department of Pharmacology, University of Arizona, Tucson, USA
- Mayo Clinic Arizona, Phoenix, USA
| | - Edita Navratilova
- Department of Pharmacology, University of Arizona, Tucson, USA
- Mayo Clinic Arizona, Phoenix, USA
| | - Joe Hirman
- Pacific Northwest Statistical Consulting, Woodinville, USA
| | - Antoinette Maassen van den Brink
- Department of Internal Medicine, Division of Pharmacology, Vascular Medicine and Metabolic Diseases, Erasmus MC University Medical Center Rotterdam, The Netherlands
| | - Richard B Lipton
- Departments of Neurology, Psychiatry and Behavioral Science, and Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - David W Dodick
- Mayo Clinic Arizona, Phoenix, USA
- Atria Academy of Science and Medicine, New York, USA
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10
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Baranoglu Kilinc Y, Torun IE, Kilinc E. D2 dopamine receptor-mediated mechanisms of dopaminergic system modulation in in vivo and in vitro experimental models of migraine. Eur J Neurosci 2024; 59:1177-1193. [PMID: 37539658 DOI: 10.1111/ejn.16106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 07/12/2023] [Accepted: 07/20/2023] [Indexed: 08/05/2023]
Abstract
The dopaminergic system is implicated in the pathophysiology of migraine. However, the underlying mechanisms remain unclear. We explored the effects and mechanisms of dopaminergic system modulation in the in vivo and in vitro rat models of migraine. Dopaminergic agonist apomorphine, D2 receptor antagonists metoclopramide and haloperidol and 5-HT3 receptor antagonist ondansetron alone and together were tested in nitroglycerin-induced migraine model, in vivo. Likewise, the combinations of drugs were also tested on basal calcitonin gene-related peptide (CGRP) release in vitro hemiskull preparations. Mechanical allodynia was tested by von Frey filaments. CGRP concentrations in trigeminovascular structures and in vitro superfusates and c-Fos levels in the brainstem were determined by enzyme-linked immunosorbent assay. Meningeal mast cells were evaluated with toluidine blue staining. Apomorphine further enhanced nitroglycerin-induced mechanical allodynia, brainstem c-fos expression, trigeminal ganglion and brainstem CGRP concentrations and meningeal mast cell degranulation, in vivo. Haloperidol completely antagonised all apomorphine-induced effects and also alleviated changes induced by nitroglycerin without apomorphine. Metoclopramide and ondansetron partially attenuated apomorphine- or nitroglycerin-induced effects. A combination of haloperidol and ondansetron decreased basal CGRP release, in vitro, whereas the other administrations were ineffective. Apomorphine-mediated dopaminergic activation exacerbated nitroglycerin-stimulated nociceptive reactions by further enhancing c-fos expression, CGRP release and mast cell degranulation in strategical structures associated with migraine pain. Metoclopramide partially attenuated the effects of apomorphine, most likely because it is also a 5-HT3 receptor antagonist. Haloperidol with pure D2 receptor antagonism feature appears to be more effective than metoclopramide in reducing migraine-related parameters in dopaminergic activation- and/or NTG-induced migraine-like conditions.
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Affiliation(s)
| | - Ibrahim Ethem Torun
- Department of Physiology, Medical School, University of Bolu Abant Izzet Baysal, Bolu, Turkey
| | - Erkan Kilinc
- Department of Physiology, Medical School, University of Bolu Abant Izzet Baysal, Bolu, Turkey
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11
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Godley F, Meitzen J, Nahman-Averbuch H, O'Neal MA, Yeomans D, Santoro N, Riggins N, Edvinsson L. How Sex Hormones Affect Migraine: An Interdisciplinary Preclinical Research Panel Review. J Pers Med 2024; 14:184. [PMID: 38392617 PMCID: PMC10889915 DOI: 10.3390/jpm14020184] [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: 12/19/2023] [Revised: 01/26/2024] [Accepted: 01/30/2024] [Indexed: 02/24/2024] Open
Abstract
Sex hormones and migraine are closely interlinked. Women report higher levels of migraine symptoms during periods of sex hormone fluctuation, particularly during puberty, pregnancy, and perimenopause. Ovarian steroids, such as estrogen and progesterone, exert complex effects on the peripheral and central nervous systems, including pain, a variety of special sensory and autonomic functions, and affective processing. A panel of basic scientists, when challenged to explain what was known about how sex hormones affect the nervous system, focused on two hormones: estrogen and oxytocin. Notably, other hormones, such as progesterone, testosterone, and vasopressin, are less well studied but are also highlighted in this review. When discussing what new therapeutic agent might be an alternative to hormone therapy and menopause replacement therapy for migraine treatment, the panel pointed to oxytocin delivered as a nasal spray. Overall, the conclusion was that progress in the preclinical study of hormones on the nervous system has been challenging and slow, that there remain substantial gaps in our understanding of the complex roles sex hormones play in migraine, and that opportunities remain for improved or novel therapeutic agents. Manipulation of sex hormones, perhaps through biochemical modifications where its positive effects are selected for and side effects are minimized, remains a theoretical goal, one that might have an impact on migraine disease and other symptoms of menopause. This review is a call to action for increased interest and funding for preclinical research on sex hormones, their metabolites, and their receptors. Interdisciplinary research, perhaps facilitated by a collaborative communication network or panel, is a possible strategy to achieve this goal.
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Affiliation(s)
- Frederick Godley
- Association of Migraine Disorders, P.O. Box 870, North Kingstown, RI 02852, USA
| | - John Meitzen
- Department of Biological Sciences, NC State University, Raleigh, NC 27695, USA
| | - Hadas Nahman-Averbuch
- Division of Clinical and Translational Research, Department of Anesthesiology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | | | - David Yeomans
- Department of Anesthesia, Pain and Perioperative Medicine, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA 94305, USA
| | - Nanette Santoro
- Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, CO 80045, USA
| | - Nina Riggins
- Brain Performance Center and Research Institute, San Diego, CA 92122, USA
| | - Lars Edvinsson
- Division of Experimental Vascular Research, Department of Clinical Sciences, Lund University Hospital, 22185 Lund, Sweden
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12
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Sun S, Fan Z, Liu X, Wang L, Ge Z. Microglia TREM1-mediated neuroinflammation contributes to central sensitization via the NF-κB pathway in a chronic migraine model. J Headache Pain 2024; 25:3. [PMID: 38177990 PMCID: PMC10768449 DOI: 10.1186/s10194-023-01707-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 12/20/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND Neuroinflammation, mediated by the activation of microglia, contributes to central sensitization, which is associated with the development of chronic migraine (CM). TREM1 receptors amplify the inflammatory response. However, their relationship to CM is unclear. Thus, this study endeavoured to elucidate the exact role of TREM1 in CM. METHODS Nitroglycerin (NTG) was repeatedly administered intraperitoneally to establish the CM model. Mechanical and thermal sensitivities were assessed using von Frey filaments and hot plate assays. Using Western blotting, TREM1, NF-κB pathway, NLRP3 inflammasome components, and proinflammatory cytokines were all detected. Immunofluorescence was used to examine the cellular distribution of TREM1 and NLRP3, the number of microglia, immunoreactivity, and morphological changes. We examined the effects of TREM1 antagonists (LR12) and NF-κB inhibitors (PDTC) on pain behaviour, as well as the production of c-fos and CGRP. Additionally, we investigated whether LR12 and PDTC affect the activation of microglia and the NLRP3 inflammasome. We synthesized siRNA and TREM1-overexpressing plasmids to transfect BV2 cells treated with LPS and normal BV2 cells and treated TREM1-overexpressing BV2 cells with PDTC. The NF-κB pathway, NLRP3 inflammasome components, and proinflammatory cytokines were quantified using Western blotting. RESULTS Following NTG administration, the expression of TREM1 was significantly upregulated and exclusively localized in microglia in the TNC, and was well co-localized with NLRP3. Furthermore, activation of the classical NF-κB pathway was observed. Pre-treatment with LR12 and PDTC effectively attenuated mechanical hypersensitivity, suppressed the expression of c-fos and CGRP, and inhibited NF-κB activity in CM mice. Additionally, inhibition of TREM1 and NF-κB activity mitigated NTG-induced microglia and NLRP3 activation, as well as proinflammatory cytokines production. In vitro, knockdown of TREM1 resulted in attenuated activation of the NF-κB pathway following lipopolysaccharide (LPS) treatment and reduced expression of NLRP3 inflammasome components as well as proinflammatory cytokines. After TREM1 overexpression, the NF-κB pathway was activated, NLRP3 inflammasome components and proinflammatory cytokines were upregulated, and PDTC reversed this phenomenon. CONCLUSIONS Our findings suggest that TREM1 regulates microglia and NLRP3 activation via the NF-κB pathway, thereby contributing to central sensitization and implicating its involvement in chronic migraine pathogenesis.
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Affiliation(s)
- Songtang Sun
- Department of Neurology, Lanzhou University Second Hospital, Lanzhou University, Lanzhou, 730000, China
| | - Zhenzhen Fan
- Department of Neurology, Lanzhou University Second Hospital, Lanzhou University, Lanzhou, 730000, China
| | - Xuejiao Liu
- Department of Neurology, Lanzhou University Second Hospital, Lanzhou University, Lanzhou, 730000, China
| | - Longde Wang
- Expert Workstation of Academician Wang Longde, Lanzhou University Second Hospital, Lanzhou, 730000, China
| | - Zhaoming Ge
- Department of Neurology, Lanzhou University Second Hospital, Lanzhou University, Lanzhou, 730000, China.
- Gansu Provincial Neurology Clinical Medical Research Center, Lanzhou University Second Hospital, Lanzhou, 730000, China.
- Expert Workstation of Academician Wang Longde, Lanzhou University Second Hospital, Lanzhou, 730000, China.
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13
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De Matteis E, Ornello R, Sacco S. Menstrually associated migraine. HANDBOOK OF CLINICAL NEUROLOGY 2024; 199:331-351. [PMID: 38307655 DOI: 10.1016/b978-0-12-823357-3.00023-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2024]
Abstract
Menstrually related migraine is a disabling condition affecting 35% to 54% females with migraine during their fertile years. The International Headache Classification distinguishes menstrually related migraine from pure menstrual migraine based on the occurrence of the attacks even outside the perimenstrual periods. Hormonal fluctuations are the main driver for the disease in subjects with genetic susceptibility and alterations of brain structures and connectivity. Menstrually related attacks are often particularly severe and disabling requiring proper management. Acute treatment mainly consists of nonsteroidal anti-inflammatory drugs (NSAIDs), recommended in patients also suffering from dysmenorrhea, and triptans. Prevention is specifically indicated in women with high monthly headache frequency or burdensome attacks during perimenstrual periods. Trials proved the efficacy of short-term prevention with triptans and NSAIDs but did not evaluate possible long-term effectiveness and tolerability. Evidence of prevention using hormonal treatments is poor, but extended-cycle treatments might be suitable for women requiring hormonal replacement for concomitant conditions. Few data are available on treatments targeting CGRP, among whom gepants are the most promising because of their utility both in migraine acute and preventive treatment. A greater recognition of disease and a deep knowledge of patients' comorbidities are essential to its proper management.
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Affiliation(s)
- Eleonora De Matteis
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Raffaele Ornello
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Simona Sacco
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy.
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van Lohuizen R, Paungarttner J, Lampl C, MaassenVanDenBrink A, Al-Hassany L. Considerations for hormonal therapy in migraine patients: a critical review of current practice. Expert Rev Neurother 2023; 24:1-21. [PMID: 38112066 PMCID: PMC10791067 DOI: 10.1080/14737175.2023.2296610] [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: 07/18/2023] [Accepted: 12/06/2023] [Indexed: 12/20/2023]
Abstract
INTRODUCTION Migraine, a neurovascular headache disorder, is a leading cause of disability worldwide. Within the multifaceted pathophysiology of migraine, hormonal fluctuations play an evident triggering and exacerbating role, pointing toward the need for identification and proper usage of both existing and new hormonal targets in migraine treatment. AREAS COVERED With a threefold higher incidence of migraine in women than in men, the authors delve into sex hormone-related events in migraine patients. A comprehensive overview is given of existing hormonal therapies, including oral contraceptives, intrauterine devices, transdermal and subcutaneous estradiol patches, gnRH-agonists, oral testosterone, and 5α reductase inhibitors. The authors discuss their effectiveness and risks, noting their suitability for different patient profiles. Next, novel evolving hormonal treatments, such as oxytocin and prolactin, are explored. Lastly, the authors cover hormonal conditions associated with migraine, such as polycystic ovary syndrome, endometriosis, and transgender persons receiving gender affirming hormone therapy, aiming to provide more personalized and effective solutions for migraine management. EXPERT OPINION Rigorous research into both existing and new hormonal targets, as well as the underlying pathophysiology, is needed to support a tailored approach in migraine treatment, in an ongoing effort to alleviate the impact of migraine on individuals and society.
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Affiliation(s)
- Romy van Lohuizen
- Division of Vascular Medicine and Pharmacology, Department of Internal Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | | | - Christian Lampl
- Headache Medical Center Linz, Linz, Austria
- Department of Neurology and Stroke Unit, Koventhospital Barmherzige Brüder Linz, Linz, Austria
| | - Antoinette MaassenVanDenBrink
- Division of Vascular Medicine and Pharmacology, Department of Internal Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Linda Al-Hassany
- Division of Vascular Medicine and Pharmacology, Department of Internal Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
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15
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Ha WS, Kim J, Hwang HW, Lee SH, Kim JI, Hong JY, Park SH, Han KD, Baek MS. The association between migraine and Parkinson's disease: a nationwide cohort study. Epidemiol Health 2023; 46:e2024010. [PMID: 38186247 PMCID: PMC10928470 DOI: 10.4178/epih.e2024010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 11/22/2023] [Indexed: 01/09/2024] Open
Abstract
OBJECTIVES Clinical studies have suggested an association between migraine and the occurrence of Parkinson's disease (PD). However, it is unknown whether migraine affects PD risk. We aimed to investigate the incidence of PD in patients with migraine and to determine the risk factors affecting the association between migraine and PD incidence. METHODS Using the Korean National Health Insurance System database (2002-2019), we enrolled all Koreans aged ≥40 years who participated in the national health screening program in 2009. International Classification of Diseases (10th revision) diagnostic codes and Rare Incurable Diseases System diagnostic codes were used to define patients with migraine (within 12 months of enrollment) and newly diagnosed PD. RESULTS We included 214,193 patients with migraine and 5,879,711 individuals without migraine. During 9.1 years of follow-up (55,435,626 person-years), 1,973 (0.92%) and 30,664 (0.52%) individuals with and without migraine, respectively, were newly diagnosed with PD. Following covariate adjustment, patients with migraine showed a 1.35-fold higher PD risk than individuals without migraine. The incidence of PD was not significantly different between patients with migraine with aura and those without aura. In males with migraine, underlying dyslipidemia increased the risk of PD (p=0.012). In contrast, among females with migraine, younger age (<65 years) increased the risk of PD (p=0.038). CONCLUSIONS Patients with migraine were more likely to develop PD than individuals without migraine. Preventive management of underlying comorbidities and chronic migraine may affect the incidence of PD in these patients. Future prospective randomized clinical trials are warranted to clarify this association.
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Affiliation(s)
- Woo-Seok Ha
- Department of Neurology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jaeho Kim
- Department of Neurology, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea
| | - Hee Won Hwang
- Department of Neurology, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Sue Hyun Lee
- Department of Neurology, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Ji In Kim
- Department of Neurology, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Jin Yong Hong
- Department of Neurology, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Sang Hyun Park
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, Korea
| | - Kyung Do Han
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, Korea
| | - Min Seok Baek
- Department of Neurology, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea
- Research Institute of Metabolism and Inflammation, Yonsei University Wonju College of Medicine, Wonju, Korea
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16
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Morse BL, Karian V. Supporting the Young Adulthood Transitions in Women With Migraine. Nurs Womens Health 2023; 27:457-466. [PMID: 37804861 DOI: 10.1016/j.nwh.2023.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 06/01/2023] [Accepted: 09/13/2023] [Indexed: 10/09/2023]
Abstract
Migraine is a painful neurological disorder that disproportionately affects women and has a significant impact on quality of life. This article summarizes the critical role of women's health nurses in supporting young adult women with migraine during major life transitions. Nurses can advocate for workplace or school disability accommodations for women with migraine. Nurses can also support young adult women with migraine by providing education about available treatment that becomes available after an individual's 18th birthday. Women's health nurses can also provide counseling on healthy lifestyle habits to sustain through life transitions, such as guidance on safe alcohol consumption and wellness approaches to migraine management. Through these interventions, women's health nurses can help women with migraine to succeed personally, professionally, and academically while effectively managing migraine symptoms.
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Maddahi A, Warfvinge K, Holm A, Edvinsson JCA, Reducha PV, Kazantzi S, Haanes KA, Edvinsson L. Progesterone distribution in the trigeminal system and its role to modulate sensory neurotransmission: influence of sex. J Headache Pain 2023; 24:154. [PMID: 37957603 PMCID: PMC10644471 DOI: 10.1186/s10194-023-01687-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 10/30/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND Women are disproportionately affected by migraine, representing up to 75% of all migraine cases. This discrepancy has been proposed to be influenced by differences in hormone levels between the sexes. One such hormone is progesterone. Calcitonin gene-related peptide (CGRP) system is an important factor in migraine pathophysiology and could be influenced by circulating hormones. The purpose of this study was to investigate the distribution of progesterone and its receptor (PR) in the trigeminovascular system, and to examine the role of progesterone to modulate sensory neurotransmission. METHODS Trigeminal ganglion (TG), hypothalamus, dura mater, and the basilar artery from male and female rats were carefully dissected. Expression of progesterone and PR proteins, and mRNA levels from TG and hypothalamus were analyzed by immunohistochemistry and real-time quantitative PCR. CGRP release from TG and dura mater were measured using an enzyme-linked immunosorbent assay. In addition, the vasomotor effect of progesterone on male and female basilar artery segments was investigated with myography. RESULTS Progesterone and progesterone receptor -A (PR-A) immunoreactivity were found in TG. Progesterone was located predominantly in cell membranes and in Aδ-fibers, and PR-A was found in neuronal cytoplasm and nucleus, and in satellite glial cells. The number of positive progesterone immunoreactive cells in the TG was higher in female compared to male rats. The PR mRNA was expressed in both hypothalamus and TG; however, the PR expression level was significantly higher in the hypothalamus. Progesterone did not induce a significant change neither in basal level nor upon stimulated release of CGRP from dura mater or TG in male or female rats when compared to the vehicle control. However, pre-treated with 10 µM progesterone weakly enhanced capsaicin induced CGRP release observed in the dura mater of male rats. Similarly, in male basilar arteries, progesterone significantly amplified the dilation in response to capsaicin. CONCLUSIONS In conclusion, these results highlight the potential for progesterone to modulate sensory neurotransmission and vascular responses in a complex manner, with effects varying by sex, tissue type, and the nature of the stimulus. Further investigations are needed to elucidate the underlying mechanisms and physiological implications of these findings.
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Affiliation(s)
- Aida Maddahi
- Division of Experimental Vascular Research, Department of Clinical Sciences, Lund University Hospital, Lund, Sweden.
| | - Karin Warfvinge
- Department of Clinical Experimental Research, Glostrup Research Institute, Copenhagen University Hospital, Rigshospitalet Glostrup, Copenhagen, Denmark
| | - Anja Holm
- Department of Clinical Experimental Research, Glostrup Research Institute, Copenhagen University Hospital, Rigshospitalet Glostrup, Copenhagen, Denmark
- Center for RNA Medicine, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Jacob C A Edvinsson
- Division of Experimental Vascular Research, Department of Clinical Sciences, Lund University Hospital, Lund, Sweden
| | - Philip Victor Reducha
- Department of Clinical Experimental Research, Glostrup Research Institute, Copenhagen University Hospital, Rigshospitalet Glostrup, Copenhagen, Denmark
- Center for RNA Medicine, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Spyridoula Kazantzi
- Department of Clinical Experimental Research, Glostrup Research Institute, Copenhagen University Hospital, Rigshospitalet Glostrup, Copenhagen, Denmark
- Center for RNA Medicine, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Kristian A Haanes
- Department of Clinical Experimental Research, Glostrup Research Institute, Copenhagen University Hospital, Rigshospitalet Glostrup, Copenhagen, Denmark
- Department of Biology, Section of Cell Biology and Physiology, University of Copenhagen, Copenhagen, Denmark
| | - Lars Edvinsson
- Division of Experimental Vascular Research, Department of Clinical Sciences, Lund University Hospital, Lund, Sweden
- Department of Clinical Experimental Research, Glostrup Research Institute, Copenhagen University Hospital, Rigshospitalet Glostrup, Copenhagen, Denmark
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18
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Raffaelli B, Do TP, Chaudhry BA, Ashina M, Amin FM, Ashina H. Menstrual migraine is caused by estrogen withdrawal: revisiting the evidence. J Headache Pain 2023; 24:131. [PMID: 37730536 PMCID: PMC10512516 DOI: 10.1186/s10194-023-01664-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 09/05/2023] [Indexed: 09/22/2023] Open
Abstract
OBJECTIVE To explore and critically appraise the evidence supporting the role of estrogen withdrawal in menstrual migraine. MAIN BODY Menstrual migraine, impacting about 6% of reproductive-age women, manifests as migraine attacks closely related to the menstrual cycle. The estrogen withdrawal hypothesis posits that the premenstrual drop in estrogen levels serves as a trigger of migraine attacks. Despite its wide acceptance, the current body of evidence supporting this hypothesis remains limited, warranting further validation. Estrogen is believed to exert a modulatory effect on pain, particularly within the trigeminovascular system - the anatomic and physiologic substrate of migraine pathogenesis. Nevertheless, existing studies are limited by methodologic inconsistencies, small sample sizes, and variable case definitions, precluding definitive conclusions. To improve our understanding of menstrual migraine, future research should concentrate on untangling the intricate interplay between estrogen, the trigeminovascular system, and migraine itself. This necessitates the use of robust methods, larger sample sizes, and standardized case definitions to surmount the limitations encountered in previous investigations. CONCLUSION Further research is thus needed to ascertain the involvement of estrogen withdrawal in menstrual migraine and advance the development of effective management strategies to address unmet treatment needs.
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Affiliation(s)
- Bianca Raffaelli
- Department of Neurology, Danish Headache Center, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Neurology, Charité Universitätsmedizin Berlin, Berlin, Germany
- Clinician Scientist Program, Berlin Institute of Health at Charité (BIH), Berlin, Germany
| | - Thien Phu Do
- Department of Neurology, Danish Headache Center, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Danish Knowledge Center On Headache Disorders, Glostrup, Denmark
| | - Basit Ali Chaudhry
- Department of Neurology, Danish Headache Center, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Messoud Ashina
- Department of Neurology, Danish Headache Center, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Danish Knowledge Center On Headache Disorders, Glostrup, Denmark
| | - Faisal Mohammad Amin
- Department of Neurology, Danish Headache Center, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Brain and Spinal Cord Injury, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Håkan Ashina
- Department of Neurology, Danish Headache Center, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark.
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
- Department of Brain and Spinal Cord Injury, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark.
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
- Harvard Medical School, Boston, MA, USA.
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MacGregor EA, Hutchinson S, Lai H, Dabruzzo B, Yu SY, Trugman JM, Ailani J. Safety and efficacy of ubrogepant for the acute treatment of perimenstrual migraine attacks: A post hoc analysis. Headache 2023; 63:1135-1144. [PMID: 37655536 DOI: 10.1111/head.14619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 07/11/2023] [Accepted: 07/14/2023] [Indexed: 09/02/2023]
Abstract
OBJECTIVE To evaluate the efficacy and safety of ubrogepant for the acute treatment of perimenstrual migraine (pmM) attacks. BACKGROUND Ubrogepant is an oral calcitonin gene-related peptide receptor antagonist approved for the acute treatment of migraine in adults. METHODS After completing one of two phase 3 trials, participants could enroll in a phase 3, 52-week, open-label, long-term safety extension trial and were re-randomized 1:1:1 to usual care, ubrogepant 50 mg, or ubrogepant 100 mg. This post hoc analysis evaluated the efficacy of ubrogepant in a subset of women who treated ≥1 pmM or non-pmM attack with ubrogepant. A pmM attack started on or between 2 days before and the first 3 days of menstrual bleeding. Mean (standard deviation [SD]) percentages of ubrogepant-treated attacks achieving 2-h pain freedom and pain relief were reported, with outcomes weighted equally by participant. RESULTS Of 734 women in the modified intent-to-treat population, 354 reported ≥1 menstrual cycle start date and a ubrogepant-treated headache day in the same month. A qualifying pmM and non-pmM attack was reported by 278 and 716 women, respectively. Pain freedom at 2 h was achieved in a mean (SD) of 28.7% (37.4) of pmM attacks and 22.1% (26.9) of non-pmM attacks treated with ubrogepant 50 mg (p = 0.054) and 29.7% (35.2) versus 25.3% (26.3) of attacks treated with ubrogepant 100 mg (p = 0.757). No difference was found in the mean percentage of ubrogepant-treated pmM and non-pmM attacks that achieved 2-h pain relief with ubrogepant 50 mg (64.8% [39.9] vs. 65.2% [32.4]; p = 0.683) and with 100 mg (67.1% [37.4] vs. 68.4% [30.2]; p = 0.273). Treatment-related treatment-emergent adverse events were reported by 8.8% (12/137) and 12.8% (18/141) in the ubrogepant 50 and 100 mg pmM subgroups, respectively. CONCLUSIONS Ubrogepant demonstrated similar efficacy for the treatment of pmM and non-pmM attacks. No new safety signals were identified.
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Affiliation(s)
- E Anne MacGregor
- Centre for Neuroscience, Surgery and Trauma, Blizard Institute of Cell and Molecular Science, Barts and the London School of Medicine and Dentistry, London, UK
- Centre for Reproductive Medicine, St. Bartholomew's Hospital, London, UK
| | - Susan Hutchinson
- Orange County Migraine and Headache Center, Irvine, California, USA
| | | | | | | | | | - Jessica Ailani
- Department of Neurology, MedStar Georgetown University Hospital, DC, Washington, USA
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20
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Kilinc YB, Kilinc E, Danis A, Hanci F, Turay S, Ozge A, Bolay H. Mitochondrial metabolism related markers GDF-15, FGF-21, and HIF-1α are elevated in pediatric migraine attacks. Headache 2023; 63:1076-1086. [PMID: 37596867 DOI: 10.1111/head.14618] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 07/14/2023] [Accepted: 07/24/2023] [Indexed: 08/20/2023]
Abstract
OBJECTIVE The purpose of this study was to investigate the serum levels of mitochondrial metabolism/reactive oxygen species (ROS)-related peptides (hypoxia inducible factor-1α [HIF-1α], fibroblast growth factor-21 [FGF-21], growth differentiation factor-15 [GDF-15]) and key migraine-related neuropeptides (calcitonin gene-related peptide [CGRP], pituitary adenylate cyclase-activating peptide-38 [PACAP-38], substance P [SP], and vasoactive intestinal peptide [VIP]) during migraine attacks and to evaluate their diagnostic value in pediatric migraine. BACKGROUND There is increasing evidence for the important role of impairment in oxidative mitochondrial metabolism in the pathophysiology of migraine. Potential biomarkers that may reflect the relationship between migraine and mitochondrial dysfunction are unclear. METHODS A total of 68 female pediatric migraine patients without aura and 20 female healthy controls aged 8-18 years, admitted to the hospital, were enrolled in this cross-sectional study. Serum concentrations of these molecules were determined by enzyme-linked immunosorbent assays, and clinical features and their possible diagnostic value were analyzed. RESULTS Serum levels of HIF-1α (252.4 ± 51.9 [mean ± standard deviation]) pg/mL), GDF-15 (233.7 ± 24.7 pg/mL), FGF-21 (96.1 ± 13.1 pg/mL), CGRP (44.5 ± 11.3), and PACAP-38 (504.7 ± 128.9) were significantly higher in migraine patients compared to healthy controls (199.8 ± 26.8, 192.8 ± 20.7, 79.3 ± 4.1, 34.1 ± 3.5 and 361.2 ± 86.3 pg/mL, respectively). The serum levels of these peptides were also higher in patients with chronic migraine than in patients with episodic migraine, and higher in the ictal period than in the interictal period. A positive correlation was found between attack frequency and both HIF-1α and FGF-21 levels in migraine patients. Serum levels of VIP and SP were not different between the migraine patients and healthy controls. CONCLUSION Migraine attacks are accompanied by elevated HIF-1α, FGF-21, GDF-15, CGRP, and PACAP-38 in medication-naive pediatric patients with migraine. Elevated circulating mitochondrial metabolism/ROS-related peptides suggest a mitochondrial stress in pediatric migraine attacks and may have potential diagnostic value in monitoring disease progression and treatment response in children. Novel approaches intervening with mitochondrial metabolism need to be investigated.
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Affiliation(s)
| | - Erkan Kilinc
- Department of Physiology, Bolu Abant Izzet Baysal University, Medical Faculty, Bolu, Turkey
| | - Aysegul Danis
- Department of Child Neurology, Bolu Abant Izzet Baysal University, Bolu, Turkey
| | - Fatma Hanci
- Department of Child Neurology, Bolu Abant Izzet Baysal University, Bolu, Turkey
| | - Sevim Turay
- Department of Child Neurology, Duzce University, Bolu, Turkey
| | - Aynur Ozge
- Department of Neurology, Mersin University, Medical Faculty, Mersin, Turkey
| | - Hayrunnisa Bolay
- Department of Neurology and Algology, Neuroscience and Neurotechnology Center NÖROM, Gazi University, Ankara, Turkey
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21
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Ge R, Chang J, Cao Y. Headache disorders and relevant sex and socioeconomic patterns in adolescents and young adults across 204 countries and territories: an updated global analysis. J Headache Pain 2023; 24:110. [PMID: 37592213 PMCID: PMC10436621 DOI: 10.1186/s10194-023-01648-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 08/09/2023] [Indexed: 08/19/2023] Open
Abstract
BACKGROUND Primary headache disorders are a group of highly prevalent and disabling neurological diseases that mainly consist of migraine and tension-type headache (TTH). A previous study showed that the burden of headaches peaked at a working age that ranged from 15 to 49, particularly among females, affecting their productivity and severely damaging their social interactions. METHODS The latest dataset was retrieved from the Global Burden of Disease (GBD) Study 2019. Three indicators, including prevalence, incidence, and years lived with disability (YLDs), were adopted for evaluation. The overall and specific headache burdens were fully compared and analysed at global, regional, and national levels. The ratio of female YLD rates to male YLD rates due to headaches was calculated to estimate the sex pattern. Finally, we utilized the two-tailed Spearman test to explore the potential association between socioeconomic background and headaches among young people. RESULTS Globally, for overall headache disorders, a total of 2,049,979,883 prevalent cases (95% uncertainty interval (UI): 1,864,148,110 to 2,239,388,034), 601,229,802 incident cases (95% UI: 530,329,914 to 681,007,934), and 38,355,993 YLDs (95% UI: 7,259,286 to 83,634,503) were observed for those aged 10 to 54 in 2019. Sex differences were widely found for all headache types among adolescents and young adults, especially migraine. However, the most interesting finding was that the associations we tested between the socioeconomic environment and young headache patients were positive, regardless of region or specific country or territory. CONCLUSIONS Overall, the global burden of headaches in adolescents and young adults largely increased from 1990 to 2019. Although slight declines were observed in sex differences, they remained significant and challenging. The positive correlations between headache and socioeconomic background among young people were relatively inconsistent with previous investigations, and several related hypotheses were proposed for explanation. Interdisciplinary actions involving education, policy- and law-making, and basic medical practice are desperately needed to further fight against the headache burden, promote gender equality in headache care, and eliminate the stigmatization of headache patients in student and working groups.
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Affiliation(s)
- Rongguang Ge
- Medical College of Soochow University, Soochow University, Suzhou, China
- Department of Neurology, Second Affiliated Hospital of Soochow University, 1055 Sanxiang Road, 215123, Suzhou, China
| | - Jie Chang
- Department of Occupational and Environmental Health, School of Public Health, Medical College of Soochow University, Soochow University, Suzhou, China
- Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Disease, Soochow University, Suzhou, China
| | - Yongjun Cao
- Department of Neurology, Second Affiliated Hospital of Soochow University, 1055 Sanxiang Road, 215123, Suzhou, China.
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22
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Kalkman DN, Couturier EGM, El Bouziani A, Dahdal J, Neefs J, Woudstra J, Vogel B, Trabattoni D, MaassenVanDenBrink A, Mehran R, de Winter RJ, Appelman Y. Migraine and cardiovascular disease: what cardiologists should know. Eur Heart J 2023; 44:2815-2828. [PMID: 37345664 DOI: 10.1093/eurheartj/ehad363] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 05/06/2023] [Accepted: 05/22/2023] [Indexed: 06/23/2023] Open
Abstract
Migraine is a chronic neurovascular disease with a complex, not fully understood pathophysiology with multiple causes. People with migraine suffer from recurrent moderate to severe headache attacks varying from 4 to 72 h. The prevalence of migraine is two to three times higher in women compared with men. Importantly, it is the most disabling disease in women <50 years of age due to a high number of years lived with disability, resulting in a very high global socioeconomic burden. Robust evidence exists on the association between migraine with aura and increased incidence of cardiovascular disease (CVD), in particular ischaemic stroke. People with migraine with aura have an increased risk of atrial fibrillation, myocardial infarction, and cardiovascular death compared with those without migraine. Ongoing studies investigate the relation between migraine and angina with non-obstructive coronary arteries and migraine patients with patent foramen ovale. Medication for the treatment of migraine can be preventative medication, such as beta-blockers, angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, antiepileptics, antidepressants, some of the long-acting calcitonin gene-related peptide receptor antagonists, or monoclonal antibodies against calcitonin gene-related peptide or its receptor, or acute medication, such as triptans and calcitonin gene-related peptide receptor antagonists. However, these medications might raise concerns when migraine patients also have CVD due to possible (coronary) side effects. Specifically, knowledge gaps remain for the contraindication to newer treatments for migraine. All cardiologists will encounter patients with CVD and migraine. This state-of-the-art review will outline the basic pathophysiology of migraine and the associations between migraine and CVD, discuss current therapies, and propose future directions for research.
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Affiliation(s)
- Deborah N Kalkman
- Department of Clinical and Experimental Cardiology, Heart Center; Amsterdam Cardiovascular Sciences, Amsterdam UMC-University of Amsterdam, Amsterdam, The Netherlands
| | - Emile G M Couturier
- Department of Neurology, Boerhaave Medisch Centrum, Amsterdam, The Netherlands
| | - Abdelhak El Bouziani
- Department of Clinical and Experimental Cardiology, Heart Center; Amsterdam Cardiovascular Sciences, Amsterdam UMC-University of Amsterdam, Amsterdam, The Netherlands
| | - Jorge Dahdal
- Department of Cardiology, Heart Center, Amsterdam UMC-Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Jolien Neefs
- Department of Clinical and Experimental Cardiology, Heart Center; Amsterdam Cardiovascular Sciences, Amsterdam UMC-University of Amsterdam, Amsterdam, The Netherlands
| | - Janneke Woudstra
- Department of Cardiology, Heart Center, Amsterdam UMC-Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Birgit Vogel
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Antoinette MaassenVanDenBrink
- Division of Vascular Medicine and Pharmacology, Department of Internal Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Roxana Mehran
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Robbert J de Winter
- Department of Clinical and Experimental Cardiology, Heart Center; Amsterdam Cardiovascular Sciences, Amsterdam UMC-University of Amsterdam, Amsterdam, The Netherlands
| | - Yolande Appelman
- Department of Cardiology, Heart Center, Amsterdam UMC-Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
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23
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van Welie FC, Kreft LA, Huisman JMA, Terwindt GM. Sex-specific metabolic profiling to explain the increased CVD risk in women with migraine: a narrative review. J Headache Pain 2023; 24:64. [PMID: 37277733 DOI: 10.1186/s10194-023-01601-5] [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: 02/13/2023] [Accepted: 05/23/2023] [Indexed: 06/07/2023] Open
Abstract
BACKGROUND Migraine is a disabling neurological disorder whose diagnosis is based on clinical criteria. A shortcoming of these criteria is that they do not fully capture the underlying neurobiological factors and sex-specific complications in migraine such as cardio- and cerebrovascular disease. Biomarker research can help to improve disease characterization and identify pathophysiological mechanism underlying these comorbidities. OBJECTIVE In this narrative review we searched for sex-specific metabolomics research to identify markers that may explain the migraine-cardiovascular disease (CVD) relationship. DISCUSSION Large-scale plasma metabolome analyses revealed alterations in migraine. Sex-specific findings showed a less CVD-protective HDL metabolism as well as the ApoA1 lipoprotein, especially for women with migraine. To explore other possible pathophysiological pathways, we expanded our review to include inflammatory markers, endothelial and vascular markers and sex hormones. Biological sex differences may affect the pathophysiology of migraine and its complications. CONCLUSIONS There is no general large dyslipidemia profile in migraine patients, in line with findings that the increased risk of CVD in migraine patients seems not to be due to (large artery) atherosclerosis. Sex-specific associations are indicative towards a less CVD-protective lipoprotein profile in women with migraine. Future studies into the pathophysiology of CVD and migraine need to take sex specific factors into account. By establishing the overlapping pathophysiological mechanism of migraine and CVD, and unraveling the associated effects these diseases exert on each other, better preventative measures can be identified.
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Affiliation(s)
- F C van Welie
- Department of Neurology, Leiden University Medical Center, P.O. 9600, 2300 WB, Leiden, The Netherlands
| | - L A Kreft
- Department of Neurology, Leiden University Medical Center, P.O. 9600, 2300 WB, Leiden, The Netherlands
| | - J M A Huisman
- Department of Neurology, Leiden University Medical Center, P.O. 9600, 2300 WB, Leiden, The Netherlands
| | - G M Terwindt
- Department of Neurology, Leiden University Medical Center, P.O. 9600, 2300 WB, Leiden, The Netherlands.
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24
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Raffaelli B, Storch E, Overeem LH, Terhart M, Fitzek MP, Lange KS, Reuter U. Sex Hormones and Calcitonin Gene-Related Peptide in Women With Migraine: A Cross-sectional, Matched Cohort Study. Neurology 2023; 100:e1825-e1835. [PMID: 36813730 PMCID: PMC10136010 DOI: 10.1212/wnl.0000000000207114] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 01/11/2023] [Indexed: 02/24/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Sex hormones may modulate calcitonin gene-related peptide (CGRP) release in the trigeminovascular system. We studied CGRP concentrations in plasma and tear fluid in female participants with episodic migraine (EM) and a regular menstrual cycle (RMC), female participants with EM and combined oral contraception (COC), and female participants with EM in the postmenopause. For control, we analyzed 3 corresponding groups of age-matched female participants without EM. METHODS Participants with an RMC had 2 visits: during menstruation on menstrual cycle day 2 ± 2 and in the periovulatory period on day 13 ± 2. Participants with COC were examined at day 4 ± 2 of the hormone-free interval (HFI) and between days 7 and 14 of hormone intake (HI). Postmenopausal participants were assessed once at a random time point. Plasma and tear fluid samples were collected at each visit for determination of CGRP levels with an ELISA. RESULTS A total of 180 female participants (n = 30 per group) completed the study. Participants with migraine and an RMC showed statistically significantly higher CGRP concentrations in plasma and tear fluid during menstruation compared with female participants without migraine (plasma: 5.95 pg/mL [IQR 4.37-10.44] vs 4.61 pg/mL [IQR 2.83-6.92], p = 0.020 [Mann-Whitney U test]; tear fluid: 1.20 ng/mL [IQR 0.36-2.52] vs 0.4 ng/mL [IQR 0.14-1.22], p = 0.005 [Mann-Whitney U test]). In contrast, female participants with COC and in the postmenopause had similar CGRP levels in the migraine and the control groups. In migraine participants with an RMC, tear fluid but not plasma CGRP concentrations during menstruation were statistically significantly higher compared with migraine participants under COC (p = 0.015 vs HFI and p = 0.029 vs HI, Mann-Whitney U test). DISCUSSION Different sex hormone profiles may influence CGRP concentrations in people, with current or past capacity to menstruate, with migraine. Measurement of CGRP in tear fluid was feasible and warrants further investigation.
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Affiliation(s)
- Bianca Raffaelli
- From the Department of Neurology (B.R., E.S., L.H.O., M.T., M.P.F., K.S.L., U.R.), Charité-Universitätsmedizin Berlin; Clinician Scientist Program (B.R.), Berlin Institute of Health at Charité (BIH); and Universitätsmedizin Greifswald (U.R.), Germany.
| | - Elisabeth Storch
- From the Department of Neurology (B.R., E.S., L.H.O., M.T., M.P.F., K.S.L., U.R.), Charité-Universitätsmedizin Berlin; Clinician Scientist Program (B.R.), Berlin Institute of Health at Charité (BIH); and Universitätsmedizin Greifswald (U.R.), Germany
| | - Lucas Hendrik Overeem
- From the Department of Neurology (B.R., E.S., L.H.O., M.T., M.P.F., K.S.L., U.R.), Charité-Universitätsmedizin Berlin; Clinician Scientist Program (B.R.), Berlin Institute of Health at Charité (BIH); and Universitätsmedizin Greifswald (U.R.), Germany
| | - Maria Terhart
- From the Department of Neurology (B.R., E.S., L.H.O., M.T., M.P.F., K.S.L., U.R.), Charité-Universitätsmedizin Berlin; Clinician Scientist Program (B.R.), Berlin Institute of Health at Charité (BIH); and Universitätsmedizin Greifswald (U.R.), Germany
| | - Mira Pauline Fitzek
- From the Department of Neurology (B.R., E.S., L.H.O., M.T., M.P.F., K.S.L., U.R.), Charité-Universitätsmedizin Berlin; Clinician Scientist Program (B.R.), Berlin Institute of Health at Charité (BIH); and Universitätsmedizin Greifswald (U.R.), Germany
| | - Kristin Sophie Lange
- From the Department of Neurology (B.R., E.S., L.H.O., M.T., M.P.F., K.S.L., U.R.), Charité-Universitätsmedizin Berlin; Clinician Scientist Program (B.R.), Berlin Institute of Health at Charité (BIH); and Universitätsmedizin Greifswald (U.R.), Germany
| | - Uwe Reuter
- From the Department of Neurology (B.R., E.S., L.H.O., M.T., M.P.F., K.S.L., U.R.), Charité-Universitätsmedizin Berlin; Clinician Scientist Program (B.R.), Berlin Institute of Health at Charité (BIH); and Universitätsmedizin Greifswald (U.R.), Germany
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25
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Szewczyk AK, Ulutas S, Aktürk T, Al-Hassany L, Börner C, Cernigliaro F, Kodounis M, Lo Cascio S, Mikolajek D, Onan D, Ragaglini C, Ratti S, Rivera-Mancilla E, Tsanoula S, Villino R, Messlinger K, Maassen Van Den Brink A, de Vries T. Prolactin and oxytocin: potential targets for migraine treatment. J Headache Pain 2023; 24:31. [PMID: 36967387 PMCID: PMC10041814 DOI: 10.1186/s10194-023-01557-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 02/28/2023] [Indexed: 03/28/2023] Open
Abstract
Migraine is a severe neurovascular disorder of which the pathophysiology is not yet fully understood. Besides the role of inflammatory mediators that interact with the trigeminovascular system, cyclic fluctuations in sex steroid hormones are involved in the sex dimorphism of migraine attacks. In addition, the pituitary-derived hormone prolactin and the hypothalamic neuropeptide oxytocin have been reported to play a modulating role in migraine and contribute to its sex-dependent differences. The current narrative review explores the relationship between these two hormones and the pathophysiology of migraine. We describe the physiological role of prolactin and oxytocin, its relationship to migraine and pain, and potential therapies targeting these hormones or their receptors.In summary, oxytocin and prolactin are involved in nociception in opposite ways. Both operate at peripheral and central levels, however, prolactin has a pronociceptive effect, while oxytocin appears to have an antinociceptive effect. Therefore, migraine treatment targeting prolactin should aim to block its effects using prolactin receptor antagonists or monoclonal antibodies specifically acting at migraine-pain related structures. This action should be local in order to avoid a decrease in prolactin levels throughout the body and associated adverse effects. In contrast, treatment targeting oxytocin should enhance its signalling and antinociceptive effects, for example using intranasal administration of oxytocin, or possibly other oxytocin receptor agonists. Interestingly, the prolactin receptor and oxytocin receptor are co-localized with estrogen receptors as well as calcitonin gene-related peptide and its receptor, providing a positive perspective on the possibilities for an adequate pharmacological treatment of these nociceptive pathways. Nevertheless, many questions remain to be answered. More particularly, there is insufficient data on the role of sex hormones in men and the correct dosing according to sex differences, hormonal changes and comorbidities. The above remains a major challenge for future development.
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Affiliation(s)
- Anna K Szewczyk
- Doctoral School, Medical University of Lublin, Lublin, Poland
- Department of Neurology, Medical University of Lublin, Lublin, Poland
| | - Samiye Ulutas
- Department of Neurology, Kartal Dr. Lutfi Kirdar Research and Training Hospital, Istanbul, Turkey
| | - Tülin Aktürk
- Department of Neurology, Kartal Dr. Lutfi Kirdar Research and Training Hospital, Istanbul, Turkey
| | - Linda Al-Hassany
- Division of Vascular Medicine and Pharmacology, Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Corinna Börner
- Department of Pediatrics - Dr. von Hauner Children's Hospital, LMU Hospital, Division of Pediatric Neurology and Developmental Medicine, Ludwig-Maximilians Universität München, Lindwurmstr. 4, 80337, Munich, Germany
- LMU Center for Children with Medical Complexity - iSPZ Hauner, Ludwig-Maximilians-Universität München, Lindwurmstr. 4, 80337, Munich, Germany
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
- TUM-Neuroimaging Center, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Federica Cernigliaro
- Child Neuropsychiatry Unit Department, Pro.M.I.S.E. "G D'Alessandro, University of Palermo, 90133, Palermo, Italy
| | - Michalis Kodounis
- First Department of Neurology, Eginition Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Salvatore Lo Cascio
- Child Neuropsychiatry Unit Department, Pro.M.I.S.E. "G D'Alessandro, University of Palermo, 90133, Palermo, Italy
| | - David Mikolajek
- Department of Neurology, City Hospital Ostrava, Ostrava, Czech Republic
| | - Dilara Onan
- Spine Health Unit, Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
- Department of Clinical and Molecular Medicine, Sapienza University, Rome, Italy
| | - Chiara Ragaglini
- Neuroscience Section, Department of Applied Clinical Sciences and Biotechnology, University of L'Aquila, 67100, L'Aquila, Italy
| | - Susanna Ratti
- Neuroscience Section, Department of Applied Clinical Sciences and Biotechnology, University of L'Aquila, 67100, L'Aquila, Italy
| | - Eduardo Rivera-Mancilla
- Division of Vascular Medicine and Pharmacology, Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Sofia Tsanoula
- Department of Neurology, 401 Military Hospital of Athens, Athens, Greece
| | - Rafael Villino
- Department of Neurology, Clínica Universidad de Navarra, Pamplona, Spain
| | - Karl Messlinger
- Institute of Physiology and Pathophysiology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Antoinette Maassen Van Den Brink
- Division of Vascular Medicine and Pharmacology, Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Tessa de Vries
- Division of Vascular Medicine and Pharmacology, Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands.
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26
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Simona G, Carlo B, Daria B, Michela CM, Flavia LC, Luca P. Monoclonal anti-CGRP antibodies in post-menopausal women: a real-life study. Acta Neurol Belg 2023. [PMID: 36867346 DOI: 10.1007/s13760-023-02190-5] [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: 03/04/2023]
Abstract
INTRODUCTION Migraine usually ameliorates after menopause. However, 10-29% of women still experience migraine attacks after menopause, especially if menopause is surgical. The use of monoclonal antibodies against the calcitonin gene-related peptide (CGRP) is changing the landscape of migraine treatment. This study aims to explore the effectiveness and safety of anti-CGRP monoclonal antibodies in women in menopause. METHODS Women affected by either migraine or chronic migraine and treated with an anti-CGRP monoclonal antibody for up to 1 year. Visits were scheduled every 3 months. RESULTS Women in menopause displayed a similar response compared to women of childbearing age. Among women in menopause, the women experiencing surgical menopause seemed to exhibit a similar response compared to the ones experiencing physiological menopause. Erenumab and galcanezumab displayed similar effectiveness in women in menopause. No serious adverse events were registered. DISCUSSION The effectiveness of anti-CGRP monoclonal antibodies is almost the same between women in menopause and women of childbearing age, without appreciable differences between the different antibodies.
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Affiliation(s)
- Guerzoni Simona
- Digital and Predictive Medicine, Pharmacology and Clinical Metabolic Toxicology-Headache Center and Drug Abuse-Laboratory of Clinical Pharmacology and Pharmacogenomics, Department of Specialist Medicines, AOU Policlinico di Modena, Modena, Italy
| | - Baraldi Carlo
- PhD School in Neurosciences, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy.
| | - Brovia Daria
- Digital and Predictive Medicine, Pharmacology and Clinical Metabolic Toxicology-Headache Center and Drug Abuse-Laboratory of Clinical Pharmacology and Pharmacogenomics, Department of Specialist Medicines, AOU Policlinico di Modena, Modena, Italy
| | - Cainazzo Maria Michela
- Digital and Predictive Medicine, Pharmacology and Clinical Metabolic Toxicology-Headache Center and Drug Abuse-Laboratory of Clinical Pharmacology and Pharmacogenomics, Department of Specialist Medicines, AOU Policlinico di Modena, Modena, Italy
| | - Lo Castro Flavia
- Post-Graduate School in Pharmacology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Pani Luca
- Digital and Predictive Medicine, Pharmacology and Clinical Metabolic Toxicology-Headache Center and Drug Abuse-Laboratory of Clinical Pharmacology and Pharmacogenomics, Department of Specialist Medicines, AOU Policlinico di Modena, Modena, Italy
- Pharmacology Unit, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Department of Psychiatry and Behavioral Sciences, University of Miami, Miami, USA
- VeraSci, Durham, NC, USA
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Verhagen IE, van der Arend BWH, van Casteren DS, le Cessie S, MaassenVanDenBrink A, Terwindt GM. Sex differences in migraine attack characteristics: A longitudinal E-diary study. Headache 2023; 63:333-341. [PMID: 36942410 DOI: 10.1111/head.14488] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 01/18/2023] [Accepted: 01/20/2023] [Indexed: 03/23/2023]
Abstract
OBJECTIVE In this prospective cohort study, characteristics of perimenstrual and non-perimenstrual migraine attacks in women were compared with migraine attacks in men. BACKGROUND Women report longer migraine attacks and more accompanying symptoms than men in cross-sectional questionnaire studies, but this has not been confirmed in longitudinal studies. Supposed differences could result from different characteristics specific to perimenstrual migraine attacks, or of attacks in women in general. METHODS This cohort study was performed among patients with migraine who were treated at the Leiden Headache Clinic. We assessed differences in migraine attack characteristics between men and women who were prospectively followed by a previously validated electronic headache diary. The primary outcome was "attack" duration. Differences between perimenstrual (Days -2 to +3 of the menstrual cycle) and non-perimenstrual attacks in women versus attacks in men were corrected for age, chronic migraine, and medication overuse headache. RESULTS A total of 1347 women and 284 men were included, reflecting the preponderance of women in migraine prevalence. Crude median (first and third quartile [Q1-Q3]) attack duration in men was 32.1 [17.7-53.6] h, compared to 36.7 [21.9-62.4] h for non-perimenstrual migraine attacks and 44.4 [17.9-79.0] h for perimenstrual migraine attacks in women. After correction for confounding, perimenstrual migraine attacks were 1.62 (95% confidence interval [CI] 1.47-1.79; p < 0.001) and non-perimenstrual 1.15 (95% CI 1.05-1.25; p = 0.003) times longer compared to migraine attacks in men. The mean relapse percentage in men was 9.2%, compared to 12.6% for non-perimenstrual migraine attacks, and 15.7% for perimenstrual migraine attacks. Relapse risk was greater for perimenstrual (odds ratio [OR] 2.39, 95% CI 1.93-2.95; p < 0.001), but not for non-perimenstrual (OR 1.18, 95% CI 0.97-1.45; p = 0.060) attacks. Migraine attacks in women were more often accompanied by photophobia, phonophobia, and nausea, but less often aura. CONCLUSION Compared to attacks in men, both perimenstrual and non-perimenstrual migraine attacks are of longer duration and are more often accompanied by associated symptoms. A sex-specific approach to migraine treatment and research is needed.
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Affiliation(s)
- Iris E Verhagen
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands
- Department of Internal Medicine, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Britt W H van der Arend
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands
- Department of Internal Medicine, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | | | - Saskia le Cessie
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands
| | | | - Gisela M Terwindt
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands
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Rahimi MD, Hassani P, Kheirkhah MT, Fadardi JS. Effectiveness of eye movement exercise and diaphragmatic breathing with jogging in reducing migraine symptoms: A preliminary, randomized comparison trial. Brain Behav 2023; 13:e2820. [PMID: 36454123 PMCID: PMC9847608 DOI: 10.1002/brb3.2820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 10/30/2022] [Accepted: 10/31/2022] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Migraine is a multifactorial headache disorder. Maladaptive functional networks or altered circuit-related connectivity in the brain with migraine appear to perturb the effects of usual treatments. OBJECTIVES In the present preliminary trial, we aim to study the effectiveness of performing pieces of body-mind, cognitive, or network reconstruction-based training (i.e., eye movement exercise plus jogging; EME+J and diaphragmatic breathing plus jogging; DB+J) in decreasing migraine symptoms. METHODS We used a three-arm, triple-blind, non-inferiority randomized comparison design with pre-test, post-test, and follow-up measurements to assess the effectiveness of EME+J and DB+J in the brain with migraine. Participants were randomly assigned to one of the study groups to perform either 12 consecutive weeks of EME+J (n = 22), DB+J (n = 19), or receiving, treatment as usual, TAU (n = 22). RESULTS The primary outcome statistical analysis through a linear mixed model showed a significant decrease in the frequency (p = .0001), duration (p = .003), and intensity (p = .007) of migraine attacks among the interventions and measurement times. The pairwise comparisons of simple effects showed that EME+J and DB+J effectively reduced migraine symptoms at the post-test and follow-up (p < .05). Cochran's tests showed that interventions decreased the number of menses-related migraine attacks. EME+J and DB+J effectively decreased over-the-counter (OTC) drug use, refreshed wake-up mode, and improved sleep and water drinking patterns. These are the secondary outcomes that Cochran's tests showed in the interventional groups after the interventions and at 12 months of follow-up. CONCLUSION EME+J or DB+J can be an effective and safe method with no adverse effects to decrease the symptoms of migraine attacks. Moreover, a reduction in the frequency of menstrual cycle-related attacks, OTC drug use, and improved quality of sleep and drinking water were the secondary outcomes of the post-test and a 12-month follow-up.
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Affiliation(s)
| | - Pouriya Hassani
- Department of Cognitive Neuroscience and Clinical Neuropsychology, University of Padova, Padua, Italy
| | | | - Javad Salehi Fadardi
- Faculty of Education and Psychology, Ferdowsi University of Mashhad, Mashhad, Iran.,School of Community and Global Health, Claremont Graduate University, Claremont, California, USA.,School of Psychology, Bangor University, Bangor, UK
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Spekker E, Bohár Z, Fejes-Szabó A, Szűcs M, Vécsei L, Párdutz Á. Estradiol Treatment Enhances Behavioral and Molecular Changes Induced by Repetitive Trigeminal Activation in a Rat Model of Migraine. Biomedicines 2022; 10:biomedicines10123175. [PMID: 36551931 PMCID: PMC9776064 DOI: 10.3390/biomedicines10123175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 12/04/2022] [Accepted: 12/06/2022] [Indexed: 12/13/2022] Open
Abstract
A migraine is a neurological condition that can cause multiple symptoms. It is up to three times more common in women than men, thus, estrogen may play an important role in the appearance attacks. Its exact pathomechanism is still unknown; however, the activation and sensitization of the trigeminal system play an essential role. We aimed to use an animal model, which would better illustrate the process of repeated episodic migraine attacks to reveal possible new mechanisms of trigeminal pain chronification. Twenty male (M) and forty ovariectomized (OVX) female adult rats were used for our experiment. Male rats were divided into two groups (M + SIF, M + IS), while female rats were divided into four groups (OVX + SIF, OVX + IS, OVX + E2 + SIF, OVX + E2 + IS); half of the female rats received capsules filled with cholesterol (OVX + SIF, OVX + IS), while the other half received a 1:1 mixture of cholesterol and 17β-estradiol (OVX + E2 + SIF, OVX + E2 + IS). The animals received synthetic interstitial fluid (SIF) (M + SIF, OVX + SIF, OVX + E2 + SIF) or inflammatory soup (IS) (M + IS, OVX + IS, OVX + E2 + IS) treatment on the dural surface through a cannula for three consecutive days each week (12 times in total). Behavior tests and immunostainings were performed. After IS application, a significant decrease was observed in the pain threshold in the M + IS (0.001 < p < 0.5), OVX + IS (0.01 < p < 0.05), and OVX + E2 + IS (0.001 < p < 0.05) groups compared to the control groups (M + SIF; OVX + SIF, OVX + E2 + SIF). The locomotor activity of the rats was lower in the IS treated groups (M + IS, 0.01 < p < 0.05; OVX + IS, p < 0.05; OVX + E2 + IS, 0.001 < p < 0.05), and these animals spent more time in the dark room (M + IS, p < 0.05; OVX + IS, 0.01 < p < 0.05; OVX + E2 + IS, 0.001 < p < 0.01). We found a significant difference between M + IS and OVX + E2 + IS groups (p < 0.05) in the behavior tests. Furthermore, IS increased the area covered by calcitonin gene-related peptide (CGRP) immunoreactive (IR) fibers (M + IS, p < 0.01; OVX + IS, p < 0.01; OVX + E2 + IS, p < 0.001) and the number of neuronal nitric oxide synthase (nNOS) IR cells (M + IS, 0.001< p < 0.05; OVX + IS, 0.01 < p < 0.05; OVX + E2 + IS, 0.001 < p < 0.05) in the caudal trigeminal nucleus (TNC). There was no difference between M + IS and OVX + IS groups; however, the area was covered by CGRP IR fibers (0.01 < p < 0.05) and the number of nNOS IR cells was significantly higher in the OVX + E2 + IS (p < 0.05) group than the other two IS- (M + IS, OVX + IS) treated animals. Overall, repeated administration of IS triggers activation and sensitization processes and develops nociceptive behavior changes. CGRP and nNOS levels increased significantly in the TNC after IS treatments, and moreover, pain thresholds and locomotor activity decreased with the development of photophobia. In our model, stable high estradiol levels proved to be pronociceptive. Thus, repeated trigeminal activation causes marked behavioral changes, which is more prominent in rats treated with estradiol, also reflected by the expression of the sensitization markers of the trigeminal system.
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Affiliation(s)
- Eleonóra Spekker
- ELKH-SZTE Neuroscience Research Group, University of Szeged, Semmelweis u. 6, H-6725 Szeged, Hungary
| | - Zsuzsanna Bohár
- ELKH-SZTE Neuroscience Research Group, University of Szeged, Semmelweis u. 6, H-6725 Szeged, Hungary
| | - Annamária Fejes-Szabó
- ELKH-SZTE Neuroscience Research Group, University of Szeged, Semmelweis u. 6, H-6725 Szeged, Hungary
| | - Mónika Szűcs
- Department of Medical Physics and Informatics, University of Szeged, Korányi Fasor 9, H-6720 Szeged, Hungary
| | - László Vécsei
- ELKH-SZTE Neuroscience Research Group, University of Szeged, Semmelweis u. 6, H-6725 Szeged, Hungary
- Department of Neurology, Interdisciplinary Excellence Centre, Albert Szent-Györgyi Medical School, University of Szeged, H-6725 Szeged, Hungary
- Correspondence: ; Tel.: +36-62-545-351; Fax: +36-62-545-597
| | - Árpád Párdutz
- Department of Neurology, Interdisciplinary Excellence Centre, Albert Szent-Györgyi Medical School, University of Szeged, H-6725 Szeged, Hungary
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Rossi MF, Tumminello A, Marconi M, Gualano MR, Santoro PE, Malorni W, Moscato U. Sex and gender differences in migraines: a narrative review. Neurol Sci 2022; 43:5729-5734. [PMID: 35676560 PMCID: PMC9176156 DOI: 10.1007/s10072-022-06178-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 05/26/2022] [Indexed: 11/29/2022]
Abstract
Introduction Gender medicine is a new medical approach aimed at the study of the differences between women and men in terms of prevention, diagnosis, and the outcome of all diseases. Migraines are among these. They represent the most common neurological illness; they are most prevalent in adults between 20 and 50 years of age and are three to four times more frequent in woman than in men. Affecting people in working age, migraines are a problem that strongly impacts the psychophysical health and productivity of workers, regardless of the specific job task they have. Methods A narrative review was performed, searching for the most relevant articles describing gender differences in people suffering from migraines, and particularly in workers. Results Migraine global prevalence is 20.7% in women and 9.7% in men whereas prevalence in Italy is 32.9% for women and only 13.0% for men. This difference is partly explained by hormonal differences, as well as by differences in brain structure, genetic polymorphisms and neuronal pathways. Sex differences may also play a role in the progression from episodic to chronic migraine. In workers, migraines are mostly associated with strenuous physical work in men, whilst migraines triggered by night shifts, lack of sleep, or irregular sleep patterns are more common in women. Conclusions To this day, the reasons of sex/gender disparity for migraine are still obscure. However, migraines, chronic migraine in particular, have a negative impact on the lives of all individuals affected by this disease, but particularly in women in which family cares and working activity are often superimposed. Migraine prevention strategies should be planned in workers through the occupational health physician.
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Affiliation(s)
- Maria Francesca Rossi
- Department of Life Sciences and Public Health, Section of Occupational Health, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168, Rome, Italy
| | - Antonio Tumminello
- Department of Life Sciences and Public Health, Section of Occupational Health, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168, Rome, Italy
| | - Matteo Marconi
- Center for Gender-Specific Medicine, Istituto Superiore Di Sanità, Rome, Italy
| | - Maria Rosaria Gualano
- Department of Public Health Sciences and Paediatrics, University of Torino, 10124, Torino, Italy
| | - Paolo Emilio Santoro
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Francesco Vito 1, 00168, Rome, Italy
- Department of Health Science and Public Health, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168, Rome, Italy
| | - Walter Malorni
- Center for Global Health Research and Studies, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168, Rome, Italy.
- Gemelli Woman Health Center for Digital Health and Personalized Medicine, Università Cattolica del Sacro Cuore, Rome, Italy.
| | - Umberto Moscato
- Department of Life Sciences and Public Health, Section of Occupational Health, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168, Rome, Italy
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Francesco Vito 1, 00168, Rome, Italy
- Department of Health Science and Public Health, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168, Rome, Italy
- Center for Global Health Research and Studies, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168, Rome, Italy
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Rubio-Beltrán E, Schoon RM, van den Berg J, Schuiling-Veninga CCM, Koch BCP, Villalón CM, Versmissen J, Danser AHJ, van den Meiracker AH, Ibrahimi K, MaassenVanDenBrink A. Trigeminovascular effects of propranolol in men and women, role for sex steroids. Ann Clin Transl Neurol 2022; 9:1405-1416. [PMID: 36029132 PMCID: PMC9463958 DOI: 10.1002/acn3.51640] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 07/11/2022] [Accepted: 07/17/2022] [Indexed: 11/08/2022] Open
Abstract
Objective Assess whether propranolol modulates the trigeminovascular system in both men and women. Methods We investigated the effect of propranolol (80 mg, 90 min after oral administration, corresponding to Tmax) on the increase in dermal blood flow of the forehead skin (innervated by the trigeminal nerve) by capsaicin application (0.6 mg/mL) and electrical stimulation (0.2–1.0 mA) before and after placebo (grapefruit juice) or propranolol (oral solution diluted in grapefruit juice) in a randomized, double‐blind, placebo‐controlled cross‐over study, including healthy males (n = 10) and females on contraceptives (n = 11). Additionally, we compared our results with data from the Dutch IADB.nl prescription database by analyzing the change in triptan use after propranolol prescription in a population similar to our dermal blood flow study subjects (males and females, 20–39 years old). Results Dermal blood flow responses to capsaicin were significantly attenuated after propranolol, but not after placebo. When stratifying by sex, no significant changes in the capsaicin‐induced dermal blood flow were observed in females after propranolol, whereas they remained significant in males. Dermal blood flow responses to electrical stimulation were not modified in any case. In our prescription database study, after propranolol, a more pronounced decrease in triptan use was observed in male patients than in female patients. Interpretation Propranolol (80 mg) inhibits capsaicin‐induced increases in dermal blood flow in a sex‐dependent manner. In patients, a more pronounced decrease in triptan use is observed in males when compared with females, suggesting an interaction between propranolol and sex steroids in the modulation of the trigeminovascular system.
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Affiliation(s)
- Eloísa Rubio-Beltrán
- Division of Pharmacology, Vascular Medicine and Metabolic Diseases, Department of Internal Medicine, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Rianne M Schoon
- Division of Pharmacology, Vascular Medicine and Metabolic Diseases, Department of Internal Medicine, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Jeffrey van den Berg
- Division of Pharmacology, Vascular Medicine and Metabolic Diseases, Department of Internal Medicine, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Catharina C M Schuiling-Veninga
- Unit of PharmacoTherapy, -Epidemiology and -Economics, University of Groningen, Groningen Research Institute of Pharmacy, Groningen, The Netherlands
| | - Birgit C P Koch
- Department of Pharmacy, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Carlos M Villalón
- Pharmacobiology Department, Cinvestav-Coapa, Tenorios 235, 14330, Mexico City, Mexico
| | - Jorie Versmissen
- Division of Pharmacology, Vascular Medicine and Metabolic Diseases, Department of Internal Medicine, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - A H Jan Danser
- Division of Pharmacology, Vascular Medicine and Metabolic Diseases, Department of Internal Medicine, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Anton H van den Meiracker
- Division of Pharmacology, Vascular Medicine and Metabolic Diseases, Department of Internal Medicine, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Khatera Ibrahimi
- Division of Pharmacology, Vascular Medicine and Metabolic Diseases, Department of Internal Medicine, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Antoinette MaassenVanDenBrink
- Division of Pharmacology, Vascular Medicine and Metabolic Diseases, Department of Internal Medicine, Erasmus University Medical Centre, Rotterdam, The Netherlands
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Frank F, Kaltseis K, Messlinger K, Broessner G. Short Report of Longitudinal CGRP-Measurements in Migraineurs During a Hypoxic Challenge. Front Neurol 2022; 13:925748. [PMID: 35968307 PMCID: PMC9367467 DOI: 10.3389/fneur.2022.925748] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 06/23/2022] [Indexed: 11/13/2022] Open
Abstract
Background Calcitonin gene related peptide (CGRP) plays a key role in the pathophysiology of migraine and is therefore considered a potential biomarker for primary headache disorders. The challenge remaining is establishing standardized protocols for its assessment in various extracellular compartments and identifying pathological situations associated with an increase in CGRP. Methods We performed longitudinal measurements of CGRP plasma levels in 30 volunteers with the diagnosis of episodic migraine with and without aura under controlled circumstances during an induced migraine attack under a hypoxic challenge. Blood samples were collected from a cubital vein and CGRP plasma levels measured using ELISA. Results CGRP levels varied significantly between the subjects at baseline (15.48–1,889.31 pg/ml) but were neither associated with socio-demographic data nor with headache/migraine frequency or intensity collected before hypoxic exposure. CGRP levels during hypoxia fluctuated around baseline and increased with prolonged hypoxia but did not differ significantly in subjects with migraine or headache compared to those without. However, subjects experiencing migraine without aura showed significantly higher levels than those with aura. Ictal CGRP levels were increased in females, in subjects with a negative family history regarding headaches, in those older than 30 years of age or with a recent headache attack before the experiment (p < 0.05). Conclusion CGRP plasma levels seem to be highly variable even at baseline in migraine patients and increased during hypoxic challenge and migraine attacks. This is the first in human longitudinal measurement of peripheral CGRP levels during induced migraine attacks using a highly standardized protocol.
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Affiliation(s)
- Florian Frank
- Department of Neurology, Headache Outpatient Clinic, Medical University of Innsbruck, Innsbruck, Austria
| | - Katharina Kaltseis
- Department of Neurology, Headache Outpatient Clinic, Medical University of Innsbruck, Innsbruck, Austria
| | - Karl Messlinger
- Institute of Physiology and Pathophysiology, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Gregor Broessner
- Department of Neurology, Headache Outpatient Clinic, Medical University of Innsbruck, Innsbruck, Austria
- *Correspondence: Gregor Broessner
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Citak A, Kilinc E, Torun IE, Ankarali S, Dagistan Y, Yoldas H. The effects of certain TRP channels and voltage-gated KCNQ/Kv7 channel opener retigabine on calcitonin gene-related peptide release in the trigeminovascular system. Cephalalgia 2022; 42:1375-1386. [PMID: 35861239 DOI: 10.1177/03331024221114773] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Calcitonin gene-related peptide release in trigeminovascular system is a pivotal component of neurogenic inflammation underlying migraine pathophysiology. Transient receptor potential channels and voltage-gated KCNQ/Kv7 potassium channels expressed throughout trigeminovascular system are important targets for modulation of calcitonin gene-related peptide release. We investigated the effects of certain transient receptor potential (TRP) channels the vanilloid 1 and 4 (TRPV1 and TRPV4), the ankyrin 1 (TRPA1), and metastatin type 8 (TRPM8), and voltage-gated potassium channel (Kv7) opener retigabine on calcitonin gene-related peptide release from peripheral (dura mater and trigeminal ganglion) and central (trigeminal nucleus caudalis) trigeminal components of rats. METHODS The experiments were carried out using well-established in-vitro preparations (hemiskull, trigeminal ganglion and trigeminal nucleus caudalis) from male Wistar rats. Agonists and antagonists of TRPV1, TRPV4, TRPA1 and TRPM8 channels, and also retigabine were tested on the in-vitro release of calcitonin gene-related peptide. Calcitonin gene-related peptide concentrations were measured using enzyme-linked immunosorbent assay. RESULTS Agonists of these transient receptor potential channels induced calcitonin gene-related peptide release from hemiskull, trigeminal ganglion and trigeminal nucleus caudalis, respectively. The transient receptor potential channels-induced calcitonin gene-related peptide releases were blocked by their specific antagonists and reduced by retigabine. Retigabine also decreased basal calcitonin gene-related peptide releases in all preparations. CONCLUSION Our findings suggest that favorable antagonists of these transient receptor potential channels, or Kv7 channel opener retigabine may be effective in migraine therapy by inhibiting neurogenic inflammation that requires calcitonin gene-related peptide release.
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Affiliation(s)
- Arzu Citak
- Department of Physiology, Faculty of Medicine, Bolu Abant Izzet Baysal University, Bolu, Turkey
| | - Erkan Kilinc
- Department of Physiology, Faculty of Medicine, Bolu Abant Izzet Baysal University, Bolu, Turkey
| | - Ibrahim Ethem Torun
- Department of Physiology, Faculty of Medicine, Bolu Abant Izzet Baysal University, Bolu, Turkey
| | - Seyit Ankarali
- Department of Physiology, Faculty of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
| | - Yasar Dagistan
- Department of Neurosurgery, Faculty of Medicine, Bolu Abant Izzet Baysal University, Bolu, Turkey
| | - Hamit Yoldas
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Bolu Abant Izzet Baysal University, Bolu, Turkey
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Yang S, Chen C, Liu X, Kang Q, Ma Q, Li P, Hu Y, Li J, Gao J, Wang T, Wang W. Xiongshao Zhitong Recipe Attenuates Nitroglycerin-Induced Migraine-Like Behaviors via the Inhibition of Inflammation Mediated by Nitric Oxide Synthase. Front Pharmacol 2022; 13:920201. [PMID: 35928284 PMCID: PMC9344691 DOI: 10.3389/fphar.2022.920201] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 06/13/2022] [Indexed: 01/14/2023] Open
Abstract
Migraine is a major cause of disability worldwide, particularly in young adults and middle-aged women. Xiongshao Zhitong Recipe (XZR) is a traditional Chinese medicine prescription used for treating migraine, but its bioactive components and therapeutic mechanisms remain unclear. We aimed to confirm the therapeutic effect of XZR on migraine and to determine the possible mechanism and bioactive components of XZR. Here, a sensitive UHPLC-LTQ-Orbitrap MS assay was carried out to analyze the ingredients of XZR, and a total of 62 components were identified, including coumarins, phenolic acids, phthalides, flavonoids, and terpenoids; among them, 15 components were identified in the serum samples after XZR treatment. We established a rat model of migraine via nitroglycerin (NTG) injection. The in vivo experiments demonstrated that XZR attenuated allodynia and photophobia in rats with NTG-induced migraine, and XZR also demonstrated analgesic effects. XZR reversed the abnormal levels of nitric oxide, 5-hydroxytryptamine (5-HT), calcitonin gene-related peptide (CGRP), and substance P (SP) to normal levels. XZR also downregulated inflammatory reactions, including mast cell degranulation and serum IL-1β, IL-6, and TNF-α levels. In terms of mechanism, we revealed that XZR treated NTG-induced migraine through the inhibition of neuronal nitric oxide synthase (nNOS) and inducible nitric oxide synthase (iNOS) expression in both the trigeminal nucleus caudalis (TNC) and periaqueductal gray matter (PAG), as well as the total NOS enzyme activity, which regulated the NF-κB signaling pathway. Additionally, imperatorin and xanthotoxin, two major ingredients of XZR, showed a high binding affinity to nNOS (Gly468-Leu616). In vitro, XZR, imperatorin, and xanthotoxin inhibited the nNOS expression and the NF-κB signaling pathway in lipopolysaccharide (LPS)-stimulated PC12 cells. In conclusion, we demonstrated the therapeutic effects of XZR and provided evidence that XZR played a critical anti-inflammatory role by suppressing NOS and NF-κB signaling pathway activation. Imperatorin and xanthotoxin were potential bioactive components of XZR. The findings from this study supported that XZR was a candidate herbal drug for migraine therapy.
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Affiliation(s)
- Song Yang
- Beijing Research Institute of Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
- State Administration of Traditional Chinese Medicine Key Laboratory of Famous Doctors and Famous Prescriptions, Beijing, China
- National Medical Products Administration Key Laboratory for Research and Evaluation of Traditional Chinese, Beijing University of Chinese Medicine, Beijing, China
| | - Cong Chen
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Xiaoyao Liu
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Qianjun Kang
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Quantao Ma
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Pin Li
- Beijing Research Institute of Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
- State Administration of Traditional Chinese Medicine Key Laboratory of Famous Doctors and Famous Prescriptions, Beijing, China
- National Medical Products Administration Key Laboratory for Research and Evaluation of Traditional Chinese, Beijing University of Chinese Medicine, Beijing, China
| | - Yujie Hu
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Jialin Li
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Jian Gao
- Beijing Research Institute of Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
- State Administration of Traditional Chinese Medicine Key Laboratory of Famous Doctors and Famous Prescriptions, Beijing, China
- National Medical Products Administration Key Laboratory for Research and Evaluation of Traditional Chinese, Beijing University of Chinese Medicine, Beijing, China
- *Correspondence: Jian Gao, ; Ting Wang, ; Weiling Wang,
| | - Ting Wang
- Beijing Research Institute of Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
- State Administration of Traditional Chinese Medicine Key Laboratory of Famous Doctors and Famous Prescriptions, Beijing, China
- National Medical Products Administration Key Laboratory for Research and Evaluation of Traditional Chinese, Beijing University of Chinese Medicine, Beijing, China
- *Correspondence: Jian Gao, ; Ting Wang, ; Weiling Wang,
| | - Weiling Wang
- Beijing Research Institute of Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
- State Administration of Traditional Chinese Medicine Key Laboratory of Famous Doctors and Famous Prescriptions, Beijing, China
- National Medical Products Administration Key Laboratory for Research and Evaluation of Traditional Chinese, Beijing University of Chinese Medicine, Beijing, China
- *Correspondence: Jian Gao, ; Ting Wang, ; Weiling Wang,
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Viero FT, Rodrigues P, Frare JM, Da Silva NAR, Ferreira MDA, Da Silva AM, Pereira GC, Ferreira J, Pillat MM, Bocchi GV, Nassini R, Geppetti P, Trevisan G. Unpredictable Sound Stress Model Causes Migraine-Like Behaviors in Mice With Sexual Dimorphism. Front Pharmacol 2022; 13:911105. [PMID: 35784726 PMCID: PMC9243578 DOI: 10.3389/fphar.2022.911105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 05/10/2022] [Indexed: 11/13/2022] Open
Abstract
Migraine represents one of the major causes of disability worldwide and is more prevalent in women; it is also related to anxiety symptoms. Stress, such as sound stress, is a frequently reported trigger in migraine patients, but the underlying mechanisms are not fully understood. However, it is known that patients with migraine have higher levels of plasma inflammatory cytokines and calcitonin gene-related peptide (CGRP). Stress mediated by unpredictable sound is already used as a model of painful sensitization, but migraine-like behaviors and sexual dimorphism have not yet been evaluated. This study characterized nociception and anxiety-related symptoms after the induction of sound stress in mice. C57BL/6 mice (20–30 g) were exposed to unpredictable sound stress for 3 days, nonconsecutive days. We observed enhanced plasma corticosterone levels on day 1 after stress induction. First, 7 days after the last stress session, mice developed hind paw and periorbital mechanical allodynia, grimacing pain behavior, anxiety-like symptoms, and reduced exploratory behavior. The nociceptive and behavioral alterations detected in this model were mostly shown in female stressed mice at day 7 post-stress. In addition, on day 7 post-stress nociception, these behaviors were consistently abolished by the CGRP receptor antagonist olcegepant (BIBN4096BS, 100 mg/kg by intraperitoneal route) in female and male stressed mice. We also demonstrated an increase in interleukine-6 (IL-6), tumor necrosis factor (TNF-α), and CGRP levels in stressed mice plasma, with female mice showing higher levels compared to male mice. This stress paradigm allows further preclinical investigation of mechanisms contributing to migraine-inducing pain.
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Affiliation(s)
- Fernanda Tibolla Viero
- Graduate Program in Pharmacology, Federal University of Santa Maria (UFSM), Santa Maria, Brazil
| | - Patrícia Rodrigues
- Graduate Program in Pharmacology, Federal University of Santa Maria (UFSM), Santa Maria, Brazil
| | - Julia Maria Frare
- Graduate Program in Pharmacology, Federal University of Santa Maria (UFSM), Santa Maria, Brazil
| | | | | | - Ana Merian Da Silva
- Graduate Program in Pharmacology, Federal University of Santa Catarina (UFSC), Florianópolis, Brazil
| | | | - Juliano Ferreira
- Graduate Program in Pharmacology, Federal University of Santa Catarina (UFSC), Florianópolis, Brazil
| | - Micheli Mainardi Pillat
- Graduate Program in Pharmacology, Federal University of Santa Maria (UFSM), Santa Maria, Brazil
| | - Guilherme Vargas Bocchi
- Graduate Program in Pharmacology, Federal University of Santa Maria (UFSM), Santa Maria, Brazil
| | - Romina Nassini
- Department of Health Science, Clinical Pharmacology and Oncology, University of Florence (UNIFI), Florence, Italy
| | - Pierangelo Geppetti
- Department of Health Science, Clinical Pharmacology and Oncology, University of Florence (UNIFI), Florence, Italy
| | - Gabriela Trevisan
- Graduate Program in Pharmacology, Federal University of Santa Maria (UFSM), Santa Maria, Brazil
- *Correspondence: Gabriela Trevisan,
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Abstract
Purpose of Review We seek to update readers on recent advances in our understanding of sex and gender in episodic migraine with a two part series. In part 1, we examine migraine epidemiology in the context of sex and gender, differences in symptomatology, and the influence of sex hormones on migraine pathophysiology (including CGRP). In part 2, we focus on practical clinical considerations for sex and gender in episodic migraine by addressing menstrual migraine and the controversial topic of hormone-containing therapies. We make note of data applicable to gender minority populations, when available, and summarize knowledge on gender affirming hormone therapy and migraine management in transgender individuals. Finally, we briefly address health disparities, socioeconomic considerations, and research bias. Recent Findings Migraine is known to be more prevalent, frequent, and disabling in women. There are also differences in migraine co-morbidities and symptomatology. For instance, women are likely to experience more migraine associated symptoms such as nausea, photophobia, and phonophobia. Migraine pathophysiology is influenced by sex hormones, e.g., estrogen withdrawal as a known trigger for migraine. Other hormones such as progesterone and testosterone are less well studied. Relationships between CGRP (the target of new acute and preventive migraine treatments) and sex hormones have been established with both animal and human model studies. The natural course of migraine throughout the lifetime suggests a contribution from hormonal changes, from puberty to pregnancy to menopause/post-menopause. Treatment of menstrual migraine and the use of hormone-containing therapies remains controversial. Re-evaluation of the data reveals that stroke risk is an estrogen dose- and aura frequency-dependent phenomenon. There are limited data on episodic migraine in gender minorities. Gender affirming hormone therapy may be associated with a change in migraine and unique risks (including ischemic stroke with high dose estrogen). Summary There are key differences in migraine epidemiology and symptomatology, thought to be driven at least in part by sex hormones which influence migraine pathophysiology and the natural course of migraine throughout the lifetime. More effective and specific treatments for menstrual migraine are needed. A careful examination of the data on estrogen and stroke risk suggests a nuanced approach to the issue of estrogen-containing contraception and hormone replacement therapy is warranted. Our understanding of sex and gender is evolving, with limited but growing research on the relationship between gender affirming therapy and migraine, and treatment considerations for transgender people with migraine.
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Schenk H, Holle D, Nsaka M, Kleinschnitz C, Glas M, Scheffler A. Twelve-month safety, tolerability and susceptibility to adverse events of prophylactic migraine therapy with erenumab: a retrospective real-world study. J Headache Pain 2022; 23:55. [PMID: 35538414 PMCID: PMC9092816 DOI: 10.1186/s10194-022-01426-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 04/30/2022] [Indexed: 01/03/2023] Open
Abstract
Background Erenumab is a monoclonal antibody (mAb) against the calcitonin gene related peptide (CGRP) receptor and is commonly used in migraine prophylaxis. Pivotal and open-label studies show a good safety and tolerability. However, little is known about possible predictors, dose dependence and time course of development of adverse events (AEs) during the treatment under real-world conditions. Methods Clinical routine data of 128 patients with migraine treated in the West German Headache Center Essen were analyzed regarding AEs during a treatment interval of up to 12 months (3mo n = 128, 6mo n = 105, 9mo n = 74, 12mo n = 54). Patients obtained subcutaneous erenumab injections with either 70 mg or 140 mg per month. The occurrence and alterations of AEs were evaluated. All reported AEs, regardless of their severity, were included. AEs were graded using the common terminology criteria for adverse events (CTCAE). Possible parameters that could influence the occurrence of AEs (sex, episodic or chronic migraine, medication overuse headache, aura and the dosage of erenumab) were analyzed using the Chi-squared test, alpha adjustment was done using the Bonferroni’s correction (6 tests, adjusted alpha = 0.0083). Results The proportion of patients who reported at least one AE were stable over the course of 12 months (after 3mo = 37%, 6mo = 36%, 9mo = 32%, 12mo = 35%). All reported AEs were grade 1 according to CTCAE with one exception (grade 2). Throughout the interval, five AEs were mostly reported: constipation, skin reactions, fatigue, sleep disturbances and nausea/emesis. Discontinuation of erenumab therapy was rarely caused by AEs (5/49). Increasing the dosage from 70 mg to 140 mg per month caused no higher frequency of AEs (Chi-squared test, p = 0.57). Significant more AEs were reported by females and by patients with aura (Chi-squared test, p < 0.001, respectively). Conclusion In general, erenumab is well tolerated up to a treatment interval of 12 months and reported AEs rarely lead to discontinuation of therapy. A higher dosage does not increase the patient reported AEs. Furthermore, no habituation of AEs is observed. Nevertheless, females and patients with aura seem to be more prone to have AEs. Trial registration No registration, retrospective analysis.
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Affiliation(s)
- Hannah Schenk
- Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), West German Headache Center, University Hospital Essen, University Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - Dagny Holle
- Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), West German Headache Center, University Hospital Essen, University Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - Michael Nsaka
- Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), West German Headache Center, University Hospital Essen, University Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - Christoph Kleinschnitz
- Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), West German Headache Center, University Hospital Essen, University Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - Martin Glas
- Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), West German Headache Center, University Hospital Essen, University Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - Armin Scheffler
- Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), West German Headache Center, University Hospital Essen, University Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany.
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Role of Estrogens in Menstrual Migraine. Cells 2022; 11:cells11081355. [PMID: 35456034 PMCID: PMC9025552 DOI: 10.3390/cells11081355] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Revised: 04/10/2022] [Accepted: 04/11/2022] [Indexed: 11/17/2022] Open
Abstract
Migraine is a major neurological disorder affecting one in nine adults worldwide with a significant impact on health care and socioeconomic systems. Migraine is more prevalent in women than in men, with 17% of all women meeting the diagnostic criteria for migraine. In women, the frequency of migraine attacks shows variations over the menstrual cycle and pregnancy, and the use of combined hormonal contraception (CHC) or hormone replacement therapy (HRT) can unveil or modify migraine disease. In the general population, 18–25% of female migraineurs display a menstrual association of their headache. Here we present an overview on the evidence supporting the role of reproductive hormones, in particular estrogens, in the pathophysiology of migraine. We also analyze the efficacy and safety of prescribing exogenous estrogens as a potential treatment for menstrual-related migraine. Finally, we point to controversial issues and future research areas in the field of reproductive hormones and migraine.
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Rustichelli C, Avallone R, Ferrari A. Atogepant: an emerging treatment for migraine. Expert Opin Pharmacother 2022; 23:653-662. [PMID: 35319319 DOI: 10.1080/14656566.2022.2057221] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Until recently, only nonspecific and not always well-tolerated medications were available for migraine prophylaxis. Currently, specific drugs such as calcitonin gene-related peptide (CGRP) monoclonal antibodies and second-generation gepants are marketed for migraine treatment. Atogepant, an orally active small molecule, is a potent, selective antagonist of the CGRP receptor and is the only gepant authorized exclusively for episodic migraine prophylaxis in adults. AREAS COVERED Using literature obtained from PubMed, Scopus, Web of Science, Cochrane, and ClinicalTrials.gov (up to February 13rd, 2022), the authors summarize and evaluate the available data on atogepant for the prophylaxis of episodic migraine. EXPERT OPINION From pivotal trials, the efficacy and tolerability of atogepant in episodic migraine prophylaxis seem comparable to those of CGRP monoclonal antibodies, even if comparative studies have not been conducted. To date, limited information is available on atogepant, including the optimal dose and duration of therapy; hence, it is difficult to establish whether it could be a first-line drug for migraine prophylaxis. Furthermore, it is important to evaluate if atogepant use is associated with the risk of cardiovascular and cerebrovascular events, which could result from potent and persistent blockade of vasodilation by CGRP.
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Affiliation(s)
- Cecilia Rustichelli
- Department of Life Sciences, University of Modena and Reggio Emilia, via Campi, Modena, Italy
| | - Rossella Avallone
- Department of Life Sciences, University of Modena and Reggio Emilia, via Campi, Modena, Italy
| | - Anna Ferrari
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, via del Pozzo, Modena, Italy
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Liang D, Sessa M. Post-marketing safety surveillance of erenumab: new insight from Eudravigilance. Expert Opin Drug Saf 2022; 21:1205-1210. [PMID: 35236231 DOI: 10.1080/14740338.2022.2049231] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND We aimed at evaluating adverse drug reactions during the post-marketing phase with erenumab as the suspected/interacting drug in Eudravigilance, with the final goal of investigating the consistency of the disproportionality signals (DS) for erenumab in Eudravigilance and the American Food and Drug Administration Adverse Event Reporting System (FDA FAERS) and undetected disproportionality signals from Eudravigilance. RESEARCH DESIGN AND METHODS Eudravigilance was screened in the period from October 2019 to October 2020. Disproportionality measure was performed using the Reporting Odds Ratio (ROR) according to the guidelines by the European Medicine Agency and using sumatriptan as the control group. RESULTS 3381 cases were reported in the study period. Forty DS were identified both in Eudravigilance and FAERS. Sixteen DS were not identified in FAERS, 10 DS were found to have a biological probability and six DS were considered false-positive and potentially related to confounding by indication. The three system organ classes with the highest proportion of adverse events were general disorders and administration site conditions (16.12%), nervous system disorders (15.95%), and gastrointestinal disorders (13.59%). CONCLUSIONS Adverse events reports were mostly reported as non-serious. The co-analysis of multiple spontaneous reported databases unveiled undetected disproportionality signals for erenumab in individual databases. Future studies should be conducted to confirm the associations and potential clinical implications.
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Affiliation(s)
- David Liang
- Ferring Pharmaceuticals, Kay Fiskers Pl. 11, 2300 København, Copenhagen, Denmark
| | - Maurizio Sessa
- Pharmacovigilance Research Center, Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen, Denmark
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Ornello R, Baraldi C, Guerzoni S, Lambru G, Fuccaro M, Raffaelli B, Gendolla A, Barbanti P, Aurilia C, Cevoli S, Favoni V, Vernieri F, Altamura C, Russo A, Silvestro M, Dalla Valle E, Mancioli A, Ranieri A, Alfieri G, Latysheva N, Filatova E, Talbot J, Cheng S, Holle D, Scheffler A, Nežádal T, Čtrnáctá D, Šípková J, Matoušová Z, Sette L, Casalena A, Maddestra M, Viola S, Affaitati G, Giamberardino MA, Pistoia F, Reuter U, Sacco S. Gender Differences in 3-Month Outcomes of Erenumab Treatment-Study on Efficacy and Safety of Treatment With Erenumab in Men. Front Neurol 2022; 12:774341. [PMID: 34975732 PMCID: PMC8717149 DOI: 10.3389/fneur.2021.774341] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Accepted: 11/02/2021] [Indexed: 11/21/2022] Open
Abstract
Objective: We reported gender-specific data on the efficacy and safety of erenumab, a monoclonal antibody antagonizing the calcitonin gene-related peptide (CGRP) receptor. Methods: Our pooled patient-level analysis of real-world data included patients treated with erenumab and followed up for 12 weeks. We considered the following outcomes at weeks 9–12 of treatment compared with baseline: 0–29%, 30–49%, 50–75%, and ≥75% responder rates, according to the decrease in monthly headache days (MHDs), rate of treatment stopping, change in MHDs, monthly migraine days (MMDs), monthly days of acute medication and triptan use, and Headache Impact Test-6 (HIT-6) score from baseline to weeks 9–12. Outcomes were compared between men and women by the chi-squared test or t-test, as appropriate. An analysis of covariance (ANCOVA) was performed to identify factors influencing the efficacy outcomes. Results: We included 1,410 patients from 16 centers, of which 256 (18.2%) were men. Men were older than women and had a lower number of MHDs at baseline. At weeks 9–12, compared with baseline, 46 (18.0%) men had a ≥75% response, 75 (29.3%) had a 50–74% response, 35 (13.7%) had a 30–49% response, and 86 (33.6%) had a 0–29% response, while 14 (5.5%) stopped the treatment. The corresponding numbers for women were 220 (19.1%), 314 (27.2%), 139 (12.0%), 402 (34.8%), and 79 (6.8%). No gender difference was found in any of the outcomes. The ANCOVA showed that gender did not influence the efficacy of outcomes. Conclusion: We found that erenumab is equally safe and effective in men compared with women after 12 weeks.
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Affiliation(s)
- Raffaele Ornello
- Neuroscience Section, Department of Applied Clinical Sciences and Biotechnology, University of L'Aquila, L'Aquila, Italy
| | - Carlo Baraldi
- Department of Biomedical, Metabolic and Neural Sciences, School in Neurosciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Simona Guerzoni
- Medical Toxicology - Headache and Drug Abuse Research Center, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Giorgio Lambru
- The Headache Service, Guy's and St Thomas' National Health Service (NHS) Foundation Trust, London, United Kingdom
| | - Matteo Fuccaro
- The Headache Service, Guy's and St Thomas' National Health Service (NHS) Foundation Trust, London, United Kingdom
| | - Bianca Raffaelli
- Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | | | - Piero Barbanti
- Headache and Pain Unit, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) San Raffaele, Rome, Italy.,San Raffaele University, Rome, Italy
| | - Cinzia Aurilia
- Headache and Pain Unit, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) San Raffaele, Rome, Italy
| | - Sabina Cevoli
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Valentina Favoni
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Fabrizio Vernieri
- Headache and Neurosonology Unit, Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Claudia Altamura
- Headache and Neurosonology Unit, Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Antonio Russo
- Headache Center, Department of Medical, Surgical, Neurological, Metabolic, and Aging Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Marcello Silvestro
- Headache Center, Department of Medical, Surgical, Neurological, Metabolic, and Aging Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | | | - Andrea Mancioli
- Headache Centre, Ospedale S. Antonio Abate, ASST Valle Olona, Gallarate, Italy
| | - Angelo Ranieri
- Headache Centre, Division of Neurology and Stroke Unit, "A. Cardarelli" Hospital, Naples, Italy
| | - Gennaro Alfieri
- Headache Centre, Division of Neurology and Stroke Unit, "A. Cardarelli" Hospital, Naples, Italy
| | - Nina Latysheva
- Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Elena Filatova
- Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Jamie Talbot
- Southwest Neurology Audit and Research Group, Department of Neurology, Derriford Hospital, Plymouth, United Kingdom
| | - Shuli Cheng
- Department of Neurology, Alfred Health, Melbourne, VIC, Australia
| | - Dagny Holle
- Department of Neurology, West German Headache Center, University Hospital Essen, Essen, Germany
| | - Armin Scheffler
- Department of Neurology, West German Headache Center, University Hospital Essen, Essen, Germany
| | - Tomáš Nežádal
- Department of Neurology, Military University Hospital Prague, First Faculty of Medicine Charles University, Prague, Czechia
| | - Dana Čtrnáctá
- Department of Neurology, Military University Hospital Prague, First Faculty of Medicine Charles University, Prague, Czechia
| | - Jitka Šípková
- Department of Neurology, Military University Hospital Prague, First Faculty of Medicine Charles University, Prague, Czechia
| | - Zuzana Matoušová
- Department of Neurology, Motol University Hospital Prague, First Faculty of Medicine Charles University, Prague, Czechia
| | - Lucia Sette
- Neuroscience Section, Department of Applied Clinical Sciences and Biotechnology, University of L'Aquila, L'Aquila, Italy
| | | | | | - Stefano Viola
- Department of Neurology, "S. Pio da Pietrelcina" Hospital, Chieti, Italy
| | - Giannapia Affaitati
- Headache Center, Geriatrics Clinic, Department of Medicine and Science of Aging and Center for Advanced Studies and Technology, G. D'Annunzio University, Chieti, Italy
| | - Maria Adele Giamberardino
- Headache Center, Geriatrics Clinic, Department of Medicine and Science of Aging and Center for Advanced Studies and Technology, G. D'Annunzio University, Chieti, Italy
| | - Francesca Pistoia
- Neuroscience Section, Department of Applied Clinical Sciences and Biotechnology, University of L'Aquila, L'Aquila, Italy
| | - Uwe Reuter
- The Headache Service, Guy's and St Thomas' National Health Service (NHS) Foundation Trust, London, United Kingdom.,Universitätsmedizin Greifswald, Greifswald, Germany
| | - Simona Sacco
- Neuroscience Section, Department of Applied Clinical Sciences and Biotechnology, University of L'Aquila, L'Aquila, Italy
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Al-Hassany L, Goadsby PJ, Danser AHJ, MaassenVanDenBrink A. Calcitonin gene-related peptide-targeting drugs for migraine: how pharmacology might inform treatment decisions. Lancet Neurol 2022; 21:284-294. [DOI: 10.1016/s1474-4422(21)00409-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 09/26/2021] [Accepted: 11/04/2021] [Indexed: 12/15/2022]
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MaassenVanDenBrink A, Terwindt GM, Cohen JM, Barash S, Campos VR, Galic M, Ning X, Kärppä M. Impact of age and sex on the efficacy of fremanezumab in patients with difficult-to-treat migraine: results of the randomized, placebo-controlled, phase 3b FOCUS study. J Headache Pain 2021; 22:152. [PMID: 34922436 PMCID: PMC8903667 DOI: 10.1186/s10194-021-01336-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 09/26/2021] [Indexed: 12/15/2022] Open
Abstract
Background Migraine prevalence is age and sex dependent, predominating in women in early and middle adulthood; however, migraine also represents a substantial burden for men and adults of all ages. Thus, understanding this burden and the efficacy of migraine preventive medications in both sexes and across age groups is critical. The randomized, placebo-controlled, double-blind, phase 3b FOCUS study demonstrated the safety and efficacy of fremanezumab, a fully humanized monoclonal antibody (IgG2∆a) that selectively targets calcitonin gene-related peptide as a migraine preventive treatment for individuals with migraine and prior inadequate response to 2 to 4 migraine preventive medication classes. Here, we assessed the efficacy of fremanezumab in participants from FOCUS subgrouped by age (18–45 years and > 45 years) and sex. Methods In the FOCUS study, eligible participants were randomized (1:1:1) to 12 weeks of double-blind treatment with quarterly fremanezumab, monthly fremanezumab, or matched monthly placebo. In this post hoc analysis, we evaluated changes from baseline in monthly migraine days (primary endpoint of FOCUS) and other secondary and exploratory efficacy outcomes in prespecified age (18–45 and > 45 years) and sex subgroups. Results The modified intention-to-treat population (received ≥ 1 dose of study drug and had ≥ 10 days of postbaseline efficacy assessments for the primary endpoint) totaled 837 participants (18–45 years, n = 373; > 45 years, n = 464; male, n = 138; female, n = 699). Consistent reductions in monthly average number of migraine days during 12 weeks were observed, regardless of age (18–45 years: quarterly fremanezumab, − 4.1 days; monthly fremanezumab, − 4.7 days; placebo, − 0.9 days; P < 0.001; > 45 years: quarterly fremanezumab, − 3.6 days; monthly fremanezumab, − 3.7 days; placebo, − 0.3 days; P < 0.001) and sex (male: quarterly fremanezumab, − 4.1 days; monthly fremanezumab, − 4.6 days; placebo, − 0.3 days; P < 0.001; female: quarterly fremanezumab, − 3.6 days; monthly fremanezumab, − 3.9 days; placebo, − 0.6 days; P < 0.001). Fremanezumab also reduced monthly headache days of at least moderate severity, monthly days of acute medication use, and improved Migraine Disability Assessment scores across subgroups. Conclusions These results demonstrate the efficacy of fremanezumab in patients with difficult-to-treat migraine for reducing migraine and headache days, acute medication use, and disability, regardless of age or sex. Trial registration ClinicalTrials.gov Identifier NCT03308968 (FOCUS), registered October 13, 2017. Supplementary Information The online version contains supplementary material available at 10.1186/s10194-021-01336-1.
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Affiliation(s)
- Antoinette MaassenVanDenBrink
- Division of Pharmacology and Vascular Medicine, Department of Internal Medicine, Erasmus University Medical Center Rotterdam, P.O. Box 2040, 3000, CA, Rotterdam, The Netherlands.
| | - Gisela M Terwindt
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | - Joshua M Cohen
- Teva Pharmaceutical Products R&D, Inc., PA, West Chester, USA
| | - Steve Barash
- Teva Pharmaceutical Products R&D, Inc., PA, West Chester, USA
| | | | - Maja Galic
- Teva Pharmaceuticals Europe B.V., Amsterdam, The Netherlands
| | - Xiaoping Ning
- Teva Pharmaceutical Products R&D, Inc., PA, West Chester, USA
| | - Mikko Kärppä
- Research Unit of Clinical Neuroscience, University of Oulu and Medical Research Center, Oulu University Hospital, Oulu, Finland
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Ornello R, Ahmed F, Negro A, Miscio AM, Santoro A, Alpuente A, Russo A, Silvestro M, Cevoli S, Brunelli N, Vernieri F, Grazzi L, Baraldi C, Guerzoni S, Andreou AP, Lambru G, Kamm K, Ruscheweyh R, Russo M, Torelli P, Filatova E, Latysheva N, Gryglas-Dworak A, Straburzyński M, Butera C, Colombo B, Filippi M, Pozo-Rosich P, Martelletti P, Sacco S. Is There a Gender Difference in the Response to onabotulinumtoxinA in Chronic Migraine? Insights from a Real-Life European Multicenter Study on 2879 Patients. Pain Ther 2021; 10:1605-1618. [PMID: 34564833 PMCID: PMC8586325 DOI: 10.1007/s40122-021-00328-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Accepted: 09/13/2021] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Migraine is mostly a female disorder because of its lower prevalence in men. Less than 20% of patients included in the available studies on migraine treatments are men; hence, the evidence on migraine treatments might not apply to men. The aims of the present study were to provide reliable information on the effectiveness of onabotulinumtoxinA (BT-A) for chronic migraine in men and to compare clinical benefits between men and women. METHODS We performed a pooled patient-level gender-specific analysis of real-life data on BT-A for chronic migraine of patients followed-up to 9 months. We reported the 50% responder rates during each BT-A cycle, defined as percentage of reduction in monthly headache days (MHDs) compared to baseline, along with 75% and 30% responder rates. We also reported the mean decrease in MHDs and in days of acute medication use (DAMs) during each BT-A cycle as compared to baseline. We also evaluated the reasons for stopping the treatment within the third cycle. RESULTS We included an overall cohort of 2879 patients, 522 of whom (18.1%) were men. In men, 50% responder rates were 27.7% during the first BT-A cycle, 29.2% during the second, and 35.6% during the third cycle; in women, the corresponding rates were 26.6%, 33.5%, and 41.0%. In the overall cohort, responder rates did not differ between men and women during the first two cycles; during the third cycle, the distribution was different (P < 0.001) mostly because of higher rates of treatment stopping and non-responders in men. In the propensity score matched cohort, the trend was maintained but lost its statistical significance. Both men and women had a significant decrease in MHDs and in DAMs with BT-A treatment (P < 0.001). There were no gender differences in those changes with the only exception of MHD decrease which, during the third cycle, was lower in men than in women (7.4 vs 8.2 days, P = 0.016 in the overall cohort and 9.1 vs 12.5 days, P = 0.009 in the propensity score matched cohort). At the end of follow-up, 152 men and 485 women stopped BT-A treatment (29.1% vs 20.6%; P < 0.001). The relative proportion of patients stopping treatment because of inadequate response (less than 30% decrease in MHDs from baseline) was higher in men than in women (42.8% vs 39.6%), while the proportion of patients stopping because of adverse events was higher in women than in men (5.6% vs 0%; P = 0.031). CONCLUSIONS Our pooled analysis suggests that the response to BT-A is significant in both men and women with a small gender difference in favor of women. Men tended to stop the treatment more frequently than women. We emphasize the need for more gender-specific data on migraine treatments from randomized controlled trials and observational studies.
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Affiliation(s)
- Raffaele Ornello
- Neuroscience Section, Department of Applied Clinical Sciences and Biotechnology, University of L’Aquila, Via Vetoio 1 Coppito, 67100 L’Aquila, Italy
| | - Fayyaz Ahmed
- Department of Neurosciences, Hull University Teaching Hospitals, Hull, UK
| | - Andrea Negro
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, Sant’Andrea Hospital, Sapienza University, 00189 Rome, RM Italy
| | - Anna Maria Miscio
- Unit of Neurology, Headache Center, Fondazione IRCCS “Casa Sollievo della Sofferenza”, San Giovanni Rotondo, FG Italy
| | - Antonio Santoro
- Unit of Neurology, Headache Center, Fondazione IRCCS “Casa Sollievo della Sofferenza”, San Giovanni Rotondo, FG Italy
| | - Alicia Alpuente
- Headache Unit, Department of Neurology, Vall d’Hebron University, Barcelona, Spain ,Headache and Neurological Pain Research Group, Department of Medicine, Vall d’Hebron Institute of Research (VHIR), Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Antonio Russo
- Department of Medical, Surgical, Neurological, Metabolic, and Aging Sciences, Headache Center, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Marcello Silvestro
- Department of Medical, Surgical, Neurological, Metabolic, and Aging Sciences, Headache Center, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Sabina Cevoli
- IRCCS Istituto delle scienze Neurologiche di Bologna, Bologna, Italy
| | - Nicoletta Brunelli
- Headache and Neurosonology Unit, Campus Bio-Medico University Hospital, Rome, Italy
| | - Fabrizio Vernieri
- Headache and Neurosonology Unit, Campus Bio-Medico University Hospital, Rome, Italy
| | - Licia Grazzi
- Neuroology Department, Headache Center, IRCCS Foundation “Carlo Besta” Neurological Institute, via Celoria,11, 20133 Milan, Italy
| | - Carlo Baraldi
- Department of Biomedical, Metabolic and Neural Sciences, Medical Toxicology-Headache and Drug Abuse Research Center, University of Modena and Reggio Emilia, Modena, Italy
| | - Simona Guerzoni
- Department of Biomedical, Metabolic and Neural Sciences, Medical Toxicology-Headache and Drug Abuse Research Center, University of Modena and Reggio Emilia, Modena, Italy
| | - Anna P. Andreou
- Headache Service, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Giorgio Lambru
- Headache Service, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Katharina Kamm
- Department of Neurology, Ludwig Maximilians University München, Munich, Germany
| | - Ruth Ruscheweyh
- Department of Neurology, Ludwig Maximilians University München, Munich, Germany
| | - Marco Russo
- Neurology Unit, Neuromotor and Rehabilitation Department, Headache Center, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | | | - Elena Filatova
- Department of Neurology, Institute for Postgraduate Education, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Nina Latysheva
- Department of Neurology, Institute for Postgraduate Education, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | | | - Marcin Straburzyński
- Headache Clinic, Terapia Neurologiczna Samodzielni, Maurycego Mochnackiego 10, 02-042 Warsaw, Poland
| | - Calogera Butera
- Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Bruno Colombo
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Massimo Filippi
- Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Milan, Italy ,Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy ,Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Patricia Pozo-Rosich
- Headache Unit, Department of Neurology, Vall d’Hebron University, Barcelona, Spain ,Headache and Neurological Pain Research Group, Department of Medicine, Vall d’Hebron Institute of Research (VHIR), Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Paolo Martelletti
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, Sant’Andrea Hospital, Sapienza University, 00189 Rome, RM Italy
| | - Simona Sacco
- Neuroscience Section, Department of Applied Clinical Sciences and Biotechnology, University of L'Aquila, Via Vetoio 1 Coppito, 67100, L'Aquila, Italy.
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Revisiting the bipolar disorder with migraine phenotype: Clinical features and comorbidity. J Affect Disord 2021; 295:156-162. [PMID: 34464877 DOI: 10.1016/j.jad.2021.08.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 08/16/2021] [Accepted: 08/18/2021] [Indexed: 01/26/2023]
Abstract
INTRODUCTION To evaluate the prevalence and clinical correlates of lifetime migraine among patients with bipolar disorder (BD). METHODS In a cross-sectional study, we evaluated 721 adults with BD from the Mayo Clinic Bipolar Disorder Biobank and compared clinical correlates of those with and without a lifetime history of migraine. A structured clinical interview (DSM-IV) and a clinician-assessed questionnaire were utilized to establish a BD diagnosis, lifetime history of migraine, and clinical correlates. RESULTS Two hundred and seven (29%) BD patients had a lifetime history of migraine. BD patients with migraine were younger and more likely to be female as compared to those without migraine (p values <0.01). In a multivariate logistic regression model, younger age (OR=0.98, p<0.01), female sex (OR=2.02, p<0.01), higher shape/weight concern (OR=1.04, p=0.02), greater anxiety disorder comorbidities (OR=1.24, p<0.01), and evening chronotype (OR=1.65, p=0.03) were associated with migraine. In separate regression models for each general medical comorbidity (controlled for age, sex, and site), migraines were significantly associated with fibromyalgia (OR=3.17, p<0.01), psoriasis (OR=2.65, p=0.03), and asthma (OR=2.0, p<0.01). Participants with migraine were receiving ADHD medication (OR=1.53, p=0.05) or compounds associated with weight loss (OR=1.53, p=0.02) at higher rates compared to those without migraine. LIMITATIONS Study design precludes determination of causality. Migraine subtypes and features were not assessed. CONCLUSIONS Migraine prevalence is high in BD and is associated with a more severe clinical burden that includes increased comorbidity with pain and inflammatory conditions. Further study of the BD-migraine phenotype may provide insight into common underlying neurobiological mechanisms.
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Silvestro M, Orologio I, Bonavita S, Scotto di Clemente F, Fasano C, Tessitore A, Tedeschi G, Russo A. Effectiveness and Safety of CGRP-mAbs in Menstrual-Related Migraine: A Real-World Experience. Pain Ther 2021; 10:1203-1214. [PMID: 34106431 PMCID: PMC8586402 DOI: 10.1007/s40122-021-00273-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 05/13/2021] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION Migraine shows a significantly higher prevalence in women, especially during reproductive age when menstrual-related hormonal fluctuations represent the most common migraine trigger. Indeed, over 50% of patients report a higher occurrence of migraine attacks during the perimenstrual window. Menstrual migraine attacks are consistently referred to as more disabling, less responsive to symptomatic treatments, longer in duration, and more prone to relapse than non-menstrual migraine attacks. Evidence strongly suggests that estrogen fluctuations are involved in migraine attacks worsening during the perimenstrual window through several mechanisms directly or indirectly involving the CGRP pathway. We aimed to evaluate whether mAbs blocking CGRP-ligand or receptor (CGRP-mAbs) could represent an effective and safe preventive treatment for menstrual migraine attacks in patients with menstrual-related migraine (MRM) with previous treatment failures. METHODS Forty patients with MRM with at least three previous treatment failures received monthly CGRP-mAbs. At the baseline and after six CGRP-mAbs administrations, patients underwent to extensive interviews to assess frequency, duration, intensity, and responsiveness to painkiller intake of migraine attacks occurring during the perimenstrual window. RESULTS After six administrations of CGRP-mAbs we observed a reduction of median menstrual migraine frequency (from 5 to 2 days per month), pain intensity (from 8/10 to 6/10), and attacks duration (from 24 to 8 h) (p < 0.001). Nevertheless, a significant increase in the percentage of responding to migraine painkillers was observed from 42.5% at baseline to 95% at T1 (p < 0.001). CONCLUSIONS CGRP-mAbs could represent a safe and effective preventive therapeutic strategy able to reduce the disabling burden of menstrual migraine attack frequency, duration, intensity, and significantly improve the response to painkillers. These findings could be related to and further indirectly prove the greater influence of CGRP-mediated mechanisms in the pathophysiology of menstrual migraine attacks.
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Affiliation(s)
- Marcello Silvestro
- Department of Advanced Medical and Surgical Sciences (DAMS), Headache Center, University of Campania "Luigi Vanvitelli", Piazza Miraglia 2, 80138, Naples, Italy
| | - Ilaria Orologio
- Department of Advanced Medical and Surgical Sciences (DAMS), Headache Center, University of Campania "Luigi Vanvitelli", Piazza Miraglia 2, 80138, Naples, Italy
| | - Simona Bonavita
- Department of Advanced Medical and Surgical Sciences (DAMS), Headache Center, University of Campania "Luigi Vanvitelli", Piazza Miraglia 2, 80138, Naples, Italy
| | - Fabrizio Scotto di Clemente
- Department of Advanced Medical and Surgical Sciences (DAMS), Headache Center, University of Campania "Luigi Vanvitelli", Piazza Miraglia 2, 80138, Naples, Italy
| | - Carla Fasano
- Department of Advanced Medical and Surgical Sciences (DAMS), Headache Center, University of Campania "Luigi Vanvitelli", Piazza Miraglia 2, 80138, Naples, Italy
| | - Alessandro Tessitore
- Department of Advanced Medical and Surgical Sciences (DAMS), Headache Center, University of Campania "Luigi Vanvitelli", Piazza Miraglia 2, 80138, Naples, Italy
| | - Gioacchino Tedeschi
- Department of Advanced Medical and Surgical Sciences (DAMS), Headache Center, University of Campania "Luigi Vanvitelli", Piazza Miraglia 2, 80138, Naples, Italy
| | - Antonio Russo
- Department of Advanced Medical and Surgical Sciences (DAMS), Headache Center, University of Campania "Luigi Vanvitelli", Piazza Miraglia 2, 80138, Naples, Italy.
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Bentivegna E, Luciani M, Scarso F, Bruscia C, Chiappino D, Amore E, Nalli G, Martelletti P. Hormonal therapies in migraine management: current perspectives on patient selection and risk management. Expert Rev Neurother 2021; 21:1347-1355. [PMID: 34739361 DOI: 10.1080/14737175.2021.2003706] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
INTRODUCTION The link between sex hormones and migraines has long been investigated but the mechanisms underlying this altered interaction are not yet fully understood. Herein, we retrace the knowledge on this association in relationship with risk of stroke. AREAS COVERED Estrogens fluctuations could trigger migraine attacks and exogenous estrogens intake could be a risk factor for venous thromboembolism (VTE) and stroke. At the same time, ischemic heart diseases and stroke share a common substrate with migraine and other mood disorders, depression, and anxiety. EXPERT OPINION The use of hormonal therapies in the context of contraception or replacement therapy must be closely evaluated in a careful risk assessment. We highlight the complex interaction of hormone/neuroinflammation pathways underlying the pathophysiology of migraine glimpsing in mood disorders a possible common denominator of link between hormonal and neuronal systems.
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Affiliation(s)
- Enrico Bentivegna
- Department of Clinical and Molecular Medicine, Sapienza University, Rome, Italy.,Regional Referral Headache Centre, Sant'Andrea Hospital, Rome, Italy
| | - Michelangelo Luciani
- Department of Clinical and Molecular Medicine, Sapienza University, Rome, Italy.,Regional Referral Headache Centre, Sant'Andrea Hospital, Rome, Italy
| | - Francesco Scarso
- Department of Clinical and Molecular Medicine, Sapienza University, Rome, Italy.,Regional Referral Headache Centre, Sant'Andrea Hospital, Rome, Italy
| | - Clara Bruscia
- Department of Clinical and Molecular Medicine, Sapienza University, Rome, Italy.,Regional Referral Headache Centre, Sant'Andrea Hospital, Rome, Italy
| | - Dario Chiappino
- Department of Clinical and Molecular Medicine, Sapienza University, Rome, Italy.,Regional Referral Headache Centre, Sant'Andrea Hospital, Rome, Italy
| | - Emanuele Amore
- Department of Clinical and Molecular Medicine, Sapienza University, Rome, Italy.,Regional Referral Headache Centre, Sant'Andrea Hospital, Rome, Italy
| | - Gabriele Nalli
- Department of Clinical and Molecular Medicine, Sapienza University, Rome, Italy.,Regional Referral Headache Centre, Sant'Andrea Hospital, Rome, Italy
| | - Paolo Martelletti
- Department of Clinical and Molecular Medicine, Sapienza University, Rome, Italy.,Regional Referral Headache Centre, Sant'Andrea Hospital, Rome, Italy
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Verhagen IE, Brandt RB, Kruitbosch CMA, MaassenVanDenBrink A, Fronczek R, Terwindt GM. Clinical symptoms of androgen deficiency in men with migraine or cluster headache: a cross-sectional cohort study. J Headache Pain 2021; 22:125. [PMID: 34666669 PMCID: PMC8525012 DOI: 10.1186/s10194-021-01334-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 09/24/2021] [Indexed: 11/25/2022] Open
Abstract
Background To compare symptoms of clinical androgen deficiency between men with migraine, men with cluster headache and non-headache male controls. Methods We performed a cross-sectional study using two validated questionnaires to assess symptoms of androgen deficiency in males with migraine, cluster headache, and non-headache controls. Primary outcome was the mean difference in androgen deficiency scores. Generalized linear models were used adjusting for age, BMI, smoking and lifetime depression. As secondary outcome we assessed the percentage of patients reporting to score below average on four sexual symptoms (beard growth, morning erections, libido and sexual potency) as these items were previously shown to more specifically differentiate androgen deficiency symptoms from (comorbid) anxiety and depression. Results The questionnaires were completed by n = 534/853 (63%) men with migraine, n = 437/694 (63%) men with cluster headache and n = 152/209 (73%) controls. Responders were older compared to non-responders and more likely to suffer from lifetime depression. Patients reported more severe symptoms of clinical androgen deficiency compared with controls, with higher AMS scores (Aging Males Symptoms; mean difference ± SE: migraine 5.44 ± 0.90, p < 0.001; cluster headache 5.62 ± 0.99, p < 0.001) and lower qADAM scores (quantitative Androgen Deficiency in the Aging Male; migraine: − 3.16 ± 0.50, p < 0.001; cluster headache: − 5.25 ± 0.56, p < 0.001). Additionally, both patient groups more often reported to suffer from any of the specific sexual symptoms compared to controls (18.4% migraine, 20.6% cluster headache, 7.2% controls, p = 0.001). Conclusion Men with migraine and cluster headache more often suffer from symptoms consistent with clinical androgen deficiency than males without a primary headache disorder.
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Affiliation(s)
- Iris E Verhagen
- Department of Neurology, Leiden University Medical Center, P.O. 9600, 2300, WB, Leiden, the Netherlands.,Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Roemer B Brandt
- Department of Neurology, Leiden University Medical Center, P.O. 9600, 2300, WB, Leiden, the Netherlands
| | - Carlijn M A Kruitbosch
- Department of Neurology, Leiden University Medical Center, P.O. 9600, 2300, WB, Leiden, the Netherlands
| | | | - Rolf Fronczek
- Department of Neurology, Leiden University Medical Center, P.O. 9600, 2300, WB, Leiden, the Netherlands
| | - Gisela M Terwindt
- Department of Neurology, Leiden University Medical Center, P.O. 9600, 2300, WB, Leiden, the Netherlands
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Hormonal influences in migraine - interactions of oestrogen, oxytocin and CGRP. Nat Rev Neurol 2021; 17:621-633. [PMID: 34545218 DOI: 10.1038/s41582-021-00544-2] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/16/2021] [Indexed: 02/07/2023]
Abstract
Migraine is ranked as the second highest cause of disability worldwide and the first among women aged 15-49 years. Overall, the incidence of migraine is threefold higher among women than men, though the frequency and severity of attacks varies during puberty, the menstrual cycle, pregnancy, the postpartum period and menopause. Reproductive hormones are clearly a key influence in the susceptibility of women to migraine. A fall in plasma oestrogen levels can trigger attacks of migraine without aura, whereas higher oestrogen levels seem to be protective. The basis of these effects is unknown. In this Review, we discuss what is known about sex hormones and their receptors in migraine-related areas in the CNS and the peripheral trigeminovascular pathway. We consider the actions of oestrogen via its multiple receptor subtypes and the involvement of oxytocin, which has been shown to prevent migraine attacks. We also discuss possible interactions of these hormones with the calcitonin gene-related peptide (CGRP) system in light of the success of anti-CGRP treatments. We propose a simple model to explain the hormone withdrawal trigger in menstrual migraine, which could provide a foundation for improved management and therapy for hormone-related migraine in women.
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50
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Lange KS, Forster O, Mawet J, Tuloup G, Burcin C, Corti L, Duflos C, Roos C, Ducros A. Type of headache at onset and risk for complications in reversible cerebral vasoconstriction syndrome. Eur J Neurol 2021; 29:130-137. [PMID: 34390103 DOI: 10.1111/ene.15064] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 08/07/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND In a recent Italian study, 30% of patients with reversible cerebral vasoconstriction syndrome (RCVS) presented without thunderclap headache (TCH), and tended to present more severe forms of RCVS than patients with TCH. We aimed to analyze the risk for complications of RCVS in patients with and without TCH at onset. METHODS In a pooled cohort of 345 French patients with RCVS, we compared patients with and without TCH at onset regarding rates of neurological complications, and the functional outcome at 3 months. RESULTS As compared to the 281 patients with TCH at onset, the 64 patients without TCH had a higher risk for any neurological complication (61% vs. 24%, OR 4.9, 95% CI 2.8-8.7, p < 0.001). The association was strongest for cervical artery dissections (28% vs. 5%, OR 8.1, 95% CI 3.7-17.6, p < 0.001), followed by posterior reversible encephalopathy syndrome (17% vs. 3%, OR 7.1, 95% CI 2.7-18.4, p < 0.001), seizures (9% vs. 2.5%, OR 4.1, 95% CI 1.3-12.5, p = 0.019), and subarachnoid hemorrhage (41% vs. 16%, OR 3.5, 95% CI 1.9-6.3, p < 0.001). In multivariable analysis, the risk for any neurological complication remained significantly elevated in the absence of TCH (OR 3.5, 95% CI 1.8-6.8, p < 0.001). The functional outcome was equal in both groups, with a modified Rankin scale score of 0-1 in ≥90% of patients. CONCLUSIONS Absence of TCH at onset might predict a higher risk of complications in RCVS. Our results warrant further multicentric studies to prove this finding.
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Affiliation(s)
- Kristin Sophie Lange
- Department of Neurology, CHU Montpellier, Hospital Gui de Chauliac, Montpellier, France.,Center for Stroke Research Berlin (CSB), Charité - Universitätsmedizin, Berlin, Germany.,Department of Neurology I Charité, Universitätsmedizin Berlin, Berlin, Germany
| | - Ophélie Forster
- Department of Neurology, CHU Montpellier, Hospital Gui de Chauliac, Montpellier, France
| | - Jérôme Mawet
- Emergency Headache Center, Department of Neurology, Lariboisière Hospital, Assistance Publique des Hôpitaux de Paris, Paris, France
| | | | - Cécilia Burcin
- Emergency Headache Center, Department of Neurology, Lariboisière Hospital, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Lucas Corti
- Department of Neurology, CHU Montpellier, Hospital Gui de Chauliac, Montpellier, France
| | - Claire Duflos
- Clinical Research and Epidemiology Unit, Department of Medical Information, CHU Montpellier, Montpellier University, Montpellier, France
| | - Caroline Roos
- Emergency Headache Center, Department of Neurology, Lariboisière Hospital, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Anne Ducros
- Department of Neurology, CHU Montpellier, Hospital Gui de Chauliac, Montpellier, France.,Charles Coulomb Laboratory, CNRS UMR5221, Montpellier University, Montpellier, France
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