Calcitonin gene-related peptide and disease activity in cluster headache. (April 2019)

• Record Type: Journal Article
• Authors: Snoer, Agneta; Vollesen, Anne Luise H; Beske, Rasmus P; Guo, Song; Hoffmann, Jan; Fahrenkrug, Jan; Jørgensen, Niklas Rye; Martinussen, Torben; Jensen, Rigmor H; Ashina, Messoud
• Is Part Of: Cephalalgia. Volume 39:Number 5(2019)
• Page Start: 575
• Page End: 584
• Publication Date: 2019-04
• Subjects: Headache -- cluster headache -- VIP -- PACAP38 -- CGRP; Headache -- Periodicals; 616.8491
• DOI: 10.1177/0333102419837154
• Languages: English
• ISSNs: 0333-1024

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.