If you have Migraine or know anyone with the disease, you’ll want to start learning about CGRP, also known as Calcitonin Gene Related Peptide.
Why? Because CGRP is once again looming on the horizon as the next important thing in treating Migraine disease.
Most Migraine researchers agree that Migraine itself is a multi-factorial process. We know lots of things that sometimes happen during an attack, but little about what we can do to stop one already in progress.
Researchers aren’t able to take lots of factors together and make as much of a difference in the Migraine patients they are trying to help because we are all different, so they find individual factors that take place as early into the attack as possible in as many people as possible. They try to target them, hoping that by stopping that one small factor, it might stop the process.
The good news is that we are seeing great strides happening in new Migraine treatments coming down the pipeline. One major player is CGRP.
CGRP and Migraine
CGRP is a complicated subject and we’re learning more and more with time and research. Here are some facts that might help you as we discuss CGRP in future SharePosts:
- CGRP is an amino acid peptide. It’s a neuropeptide. Our neurons make it, and it has been implicated in the pathogenesis of Migraine (how a Migraine begins inside our bodies).
- CGRP fits into special receptors in the body that result in potential Migraine symptoms such as pain, inflammation and vasodilation.
- There are different types of CGRP, but the one researchers are looking at especially closely seems to have only one job: Pain.
- Our brains themselves don’t have the ability to feel pain, but the trigeminal nerves that service our face and head with the sense of feeling and pain activate and release CGRP which can be found in plasma (blood) and saliva.
- CGRP can also be found in brainstem cells and on glial cells, as well as blood vessels inside our heads.
- When researchers look at patients during a Migraine, they can find increased CGRP levels that are similar to their levels of pain.
- A Migraine can be triggered when researchers give CGRP to patients who are Migraine free at that time. The more they are given, the worse the symptoms.
- When medicines are given to relieve the Migraine (triptans), CGRP levels also drop.
- Botox (onabotulinumtoxinA) is thought to be effective in part because it prevents the release of CGRP.
Most of this information we have known for some time. In fact, there was one drug developed called Telcagepant, which worked on the CGRP target we’re talking about. Unfortunately, although it worked well for acute use, when trialed as a preventive it resulted in elevated liver enzymes and sadly, was dropped as a potential treatment.
There is exciting news about researchers using the same CGRP target but in a very different way. This time, they’re using antibodies to target CGRP, and soon I’ll give you the fabulous news about that. Before that, we’ll need to talk a little bit more about how CGRP works inside our bodies, so stay tuned for Part Two
- Merck. "Insights into the pathophysiology of migraine." Migraine Resources. Copyright © 2009-2010 Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc.
- Durham, Paul, PhD. and A. Russo (2003). “Stimulation of the calcitonin gene-related peptide enhancer by mitogen-activated protein kinases and repression by an antimigraine drug in trigeminal ganglia neurons”. J Neurosci 23 (3): 807-815.
- Durham, Paul, PhD. (2006). "Calcitonin Gene-Related Peptide (CGRP) and migraine". Headache. 46 (1): S3-S8.
- Durham, Paul, PhD., Cady, Roger, MD and R. Cady (2004). “Regulation of calcitonin gene-related peptide secretion from trigeminal nerve cells by botulinum toxin type A: implications for migraine therapy”. Headache 44 (1): 35-42. doi:10.1111/j.1526-4610.2004.04007.x.
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