Calcitonin-gene related peptide and disease activity in cluster headache

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

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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.

OriginalsprogEngelsk
TidsskriftCephalalgia
Vol/bind39
Udgave nummer5
Sider (fra-til)575-584
ISSN0333-1024
DOI
StatusUdgivet - apr. 2019

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Snoer, A., Vollesen, A. L. H., Beske, R. P., Guo, S., Hoffmann, J., Fahrenkrug, J., Jørgensen, N. R., Martinussen, T., Jensen, R. H., & Ashina, M. (2019). Calcitonin-gene related peptide and disease activity in cluster headache. Cephalalgia, 39(5), 575-584. https://doi.org/10.1177/0333102419837154