Get access

Calcitonin Gene-Related Peptide Does Not Cause Migraine Attacks in Patients With Familial Hemiplegic Migraine

Authors

  • Jakob M. Hansen MD, PhD,

    1. From the Danish Headache Center, Departments of Neurology, Glostrup Hospital, Faculty of Health Sciences, University of Copenhagen, Glostrup, Copenhagen, Denmark (J.M. Hansen, J. Olesen, and M Ashina); Pediatrics , Glostrup Hospital, Faculty of Health Sciences, University of Copenhagen, Glostrup, Copenhagen, Denmark (L.L. Thomsen).
    Search for more papers by this author
  • Lise L. Thomsen MD, PhD,

    1. From the Danish Headache Center, Departments of Neurology, Glostrup Hospital, Faculty of Health Sciences, University of Copenhagen, Glostrup, Copenhagen, Denmark (J.M. Hansen, J. Olesen, and M Ashina); Pediatrics , Glostrup Hospital, Faculty of Health Sciences, University of Copenhagen, Glostrup, Copenhagen, Denmark (L.L. Thomsen).
    Search for more papers by this author
  • Jes Olesen MD, DrMSc,

    1. From the Danish Headache Center, Departments of Neurology, Glostrup Hospital, Faculty of Health Sciences, University of Copenhagen, Glostrup, Copenhagen, Denmark (J.M. Hansen, J. Olesen, and M Ashina); Pediatrics , Glostrup Hospital, Faculty of Health Sciences, University of Copenhagen, Glostrup, Copenhagen, Denmark (L.L. Thomsen).
    Search for more papers by this author
  • Messoud Ashina MD, DrMSc

    1. From the Danish Headache Center, Departments of Neurology, Glostrup Hospital, Faculty of Health Sciences, University of Copenhagen, Glostrup, Copenhagen, Denmark (J.M. Hansen, J. Olesen, and M Ashina); Pediatrics , Glostrup Hospital, Faculty of Health Sciences, University of Copenhagen, Glostrup, Copenhagen, Denmark (L.L. Thomsen).
    Search for more papers by this author

  • Study Funding: Supported by grants from the University of Copenhagen, The Danish Headache Society and through The Lundbeck Foundation Center for Neurovascular Signalling (LUCENS).

  • Conflict of Interest: Dr. Hansen and Dr. Thomsen report no disclosures. Dr. Olesen serves on scientific advisory boards for Allergan Inc., AstraZeneca, Boehringer Ingelheim, Eli Lilly and Company, GlaxoSmithKline, Janssen, MSD, Pfizer Inc, Minster Pharmaceuticals plc, ROXRO PHARMA, MAP Pharmaceuticals, NeurAxon, Inc., and Lundbeck Inc.; serves on speakers' bureaus for Allergan Inc., AstraZeneca, Boehringer Ingelheim, Eli Lilly and Company, GlaxoSmithKline, Janssen, MSD, Pfizer Inc, Minster Pharmaceuticals plc, ROXRO PHARMA, MAP Pharmaceuticals, NeurAxon, Inc., and Lundbeck Inc.; and receives research support from Lundbeck Inc. Dr. Ashina serves on scientific advisory boards and as a consultant for MSD, BTG plc, and Allergan, Inc.; has received funding for travel from MSD; serves as an Associate Editor of the Scandinavian Journal of Pain and on the editorial advisory board of The Journal of Headache and Pain; and serves on speakers' bureaus for and received speaker honoraria from MSD, Pfizer Inc, GlaxoSmithKline, Norpharma, and AstraZeneca.

M. Ashina, Danish Headache Center and Department of Neurology, Glostrup Hospital, University of Copenhagen, Faculty of Health Sciences, Nordre Ringvej 57, DK-2600 Glostrup, Copenhagen, Denmark.

Abstract

(Headache 2011;51:544-553)

Background.— Calcitonin gene-related peptide (CGRP) is a key molecule in migraine pathogenesis. Intravenous CGRP triggers migraine-like attacks in patients with migraine with aura and without aura. In contrast, patients with familial hemiplegic migraine (FHM) with known mutations did not report more migraine-like attacks compared to controls. Whether CGRP triggers migraine-like attacks in FHM patients without known mutations is unknown.

Objective.— In the present study we therefore examined the migraine-inducing effect of CGRP in FHM patients without known mutations and healthy controls.

Methods and design.— Eleven patients suffering from FHM without known mutations and 11 controls received an intravenous infusion of 1.5 µg/minute CGRP over 20 minutes. The study design was a balanced and controlled provocation study. Headache and other migraine symptoms were scored for 1 hour and self-recorded hourly thereafter until 13-hour postinfusion.

Results.— We found no difference in the incidence of migraine-like attacks between the 2 groups, with 9% (1 of 11) of patients and 0% (0 of 10) of controls reporting migraine-like headache (P = 1.00). CGRP infusion did not induce aura symptoms in any of the participants. There was no difference in the incidence of CGRP-induced delayed headaches between the groups (P = .18).

Conclusion.— In contrast to patients suffering from migraine with aura and without aura, CGRP infusion did not induce more migraine-like attacks in FHM patients without known mutations compared to controls. It seems that the majority of FHM patients with and without known mutation display no sensitivity to CGRP signaling compared to common types of migraine.

Ancillary