Calcitonin-gene related peptide and disease activity in cluster headache.

Abstract

OBJECTIVE:

To investigate the role of calcitonin gene-related peptide, pituitary adenylate cyclase-activating polypeptide-38 (PACAP38) and vasoactive intestinal polypeptide in cluster headache, we measured these vasoactive peptides interictally and during experimentally induced cluster headache attacks.

METHODS:

We included patients with episodic cluster headache in an active phase (n = 9), episodic cluster headache patients in remission (n = 9) and patients with chronic cluster headache (n = 13). Cluster headache attacks were induced by infusion of calcitonin gene-related peptide (1.5 µg/min) in a randomized, double-blind, placebo controlled, two-way cross-over study. At baseline, we collected interictal blood samples from all patients and during 11 calcitonin gene-related peptide-induced cluster headache attacks.

RESULTS:

At baseline, episodic cluster headache patients in remission had higher plasma levels of calcitonin gene-related peptide, 100.6 ± 36.3 pmol/l, compared to chronic cluster headache patients, 65.9 ± 30.5 pmol/l, ( p = 0.011). Episodic cluster headache patients in active phase had higher PACAP38 levels, 4.0 ± 0.8 pmol/l, compared to chronic cluster headache patients, 3.3 ± 0.7 pmol/l, ( p = 0.033). Baseline levels of vasoactive intestinal polypeptide did not differ between cluster headache groups. We found no attack-related increase in calcitonin gene-related peptide, PACAP38 or vasoactive intestinal polypeptide levels during calcitonin gene-related peptide-induced cluster headache attacks.

CONCLUSIONS:

This study suggests that cluster headache disease activity is associated with alterations of calcitonin gene-related peptide expression. Future studies should investigate the potential of using calcitonin gene-related peptide measurements in monitoring of disease state and predicting response to preventive treatments, including response to anti-calcitonin gene-related peptide monoclonal antibodies.

• Authors: Agneta Snoer, Anne Luise H Vollesen, Rasmus P Beske, Song Guo, Jan Hoffmann, Jan Fahrenkrug, Niklas Rye Jørgensen, Torben Martinussen, Rigmor H Jensen, Messoud Ashina
• Journal: Cephalalgia : an international journal of headache (Cephalalgia) Vol. 39 Issue 5 Pg. 575-584 (04 2019) ISSN: 1468-2982 [Electronic] England
• PMID: 30854880 (Publication Type: Journal Article, Randomized Controlled Trial)

Chemical References

• Pituitary Adenylate Cyclase-Activating Polypeptide
• Vasoactive Intestinal Peptide
• Calcitonin Gene-Related Peptide

Topics

• Adult
• Calcitonin Gene-Related Peptide (blood)
• Cluster Headache (blood)
• Cross-Over Studies
• Double-Blind Method
• Female
• Humans
• Male
• Middle Aged
• Pituitary Adenylate Cyclase-Activating Polypeptide (blood)
• Vasoactive Intestinal Peptide (blood)
• Young Adult