nach oben

Neurological Sciences

Erschienen in:

28.02.2019 | Review Article

Anti-CGRP in cluster headache therapy

verfasst von: Luca Giani, Alberto Proietti Cecchini, Massimo Leone

Erschienen in: Neurological Sciences | Sonderheft 1/2019

Einloggen, um Zugang zu erhalten

Abstract

Cluster headache is a primary headache characterized by recurring excruciating pain and autonomic signs, leading to significant suffering and derangement of patients’ life. Efficacious new preventive treatments are needed. The pathophysiology of cluster headache comprises mechanisms both in the peripheral and central nervous system, involving the trigeminovascular system, the trigemino-parasympathetic reflex, and central modulating systems. Calcitonin gene–related peptide (CGRP) has an active role throughout these systems. It is increased during spontaneous and provoked attacks, and itself can induce attacks. Recently, drugs against this neuropeptide have been developed for the treatment of different headache disorders. In particular, monoclonal antibodies vs CGRP as galcanezumab and fremanezumab have been tested in cluster headache, with promising results for the episodic form. Considering the relevance of central mechanisms in CH, drugs interfering with the CGRP pathway in the central nervous system can enlarge the therapeutic armamentarium against this highly disabling condition.

Headache Classification Committee of the International Headache Society (IHS) (2013) The International Classification of Headache Disorders, 3rd edition (beta version). Cephalagia 33:629–808. https://doi.org/10.1177/0333102413485658 CrossRef

Rozen TD, Fishman RS (2012) Cluster headache in the United States of America: demographics, clinical characteristics, triggers, suicidality, and personal burden. Headache 52:99–113. https://doi.org/10.1111/j.1526-4610.2011.02028.x CrossRefPubMed

Fischera M, Marziniak M, Gralow I, Evers S (2008) The incidence and prevalence of cluster headache: a meta-analysis of population-based studies. Cephalalgia 28:614–618. https://doi.org/10.1111/j.1468-2982.2008.01592.x CrossRefPubMed

Ekbom K, Svensson DA, Pedersen NL, Waldenlind E (2006) Lifetime prevalence and concordance risk of cluster headache in the Swedish twin population. Neurology 67:798–803. https://doi.org/10.1212/01.wnl.0000233786.72356.3e CrossRefPubMed

Torelli P, Beghi E, Manzoni GC (2005) Cluster headache prevalence in the Italian general population. Neurology 64:469–474. https://doi.org/10.1212/01.WNL.0000150901.47293.BC CrossRefPubMed

Sjaastad O, Bakketeig LS (2003) Cluster headache prevalence. Vågå study of headache epidemiology. Cephalalgia 23:528–533. https://doi.org/10.1046/j.1468-2982.2003.00585.x CrossRefPubMed

Tonon C, Guttmann S, Volpini M, Naccarato S, Cortelli P, D’Alessandro R (2002) Prevalence and incidence of cluster headache in the Republic of San Marino. Neurology 58:1407–1409. https://doi.org/10.1016/j.trac.2005.02.007 CrossRefPubMed

Evers S, Fischera M, May A, Berger K (2007) Prevalence of cluster headache in Germany: results of the epidemiological DMKG study. J Neurol Neurosurg Psychiatry 78:1289–1290. https://doi.org/10.1136/jnnp.2007.124206 CrossRefPubMedPubMedCentral

Bjørn Russell M (2004) Epidemiology and genetics of cluster headache. Lancet Neurol 3:279–283. https://doi.org/10.1016/S1474-4422(04)00735-5 CrossRef

10.

Jensen RM, Lyngberg A, Jensen RH (2007) Burden of cluster headache. Cephalalgia 27:535–541. https://doi.org/10.1111/j.1468-2982.2007.01330.x CrossRefPubMed

11.

Goadsby PJ, Lipton RB (1997) A review of paroxysmal hemicranias, SUNCT syndrome and other short-lasting headaches with autonomic feature, including new cases. Brain 120:193–209. https://doi.org/10.1093/brain/120.1.193 CrossRefPubMed

12.

Jürgens TP, May A (2014) Role of sphenopalatine ganglion stimulation in cluster headache. Curr Pain Headache Rep 18:433CrossRefPubMed

13.

Waldenlind E, Gustafsson SA, Ekbom K, Wetterberg L (1987) Circadian secretion of cortisol and melatonin in cluster headache during active cluster periods and remission. J Neurol Neurosurg Psychiatry 50:207–213. https://doi.org/10.1136/jnnp.50.2.207 CrossRefPubMedPubMedCentral

14.

Leone M, Bussone G (1993) A review of hormonal findings in cluster headache. Evidence for hypothalamic involvement. Cephalalgia 13:309–317. https://doi.org/10.1046/j.1468-2982.1993.1305309.x CrossRefPubMed

15.

May A, Bahra A, Büchel C, Frackowiak RS, Goadsby PJ (1998) Hypothalamic activation in cluster headache attacks. Lancet (London, England) 352:275–278. https://doi.org/10.1016/S0140-6736(98)02470-2 CrossRef

16.

May A, Leone M, Boecker H, Sprenger T, Juergens T, Bussone G, Tolle TR (2006) Hypothalamic deep brain stimulation in positron emission tomography. J Neurosci 26:3589–3593. https://doi.org/10.1523/JNEUROSCI.4609-05.2006 CrossRefPubMedPubMedCentral

17.

May A, Ashburner J, Büchel C, McGonigle DJ, Friston KJ, Frackowiak RSJ, Goadsby PJ (1999) Correlation between structural and functional changes in brain in an idiopathic headache syndrome. Nat Med 5:836–838. https://doi.org/10.1038/10561 CrossRefPubMed

18.

Amara SG, Jonas V, Rosenfeld MG, Ong ES, Evans RM (1982) Alternative RNA processing in calcitonin gene expression generates mRNAs encoding different polypeptide products. Nature 298:240–244. https://doi.org/10.1038/298240a0 CrossRefPubMed

19.

Skofitsch G, Jacobowitz DM (1985) Calcitonin gene-related peptide: detailed immunohistochemical distribution in the central nervous system. Peptides 6:721–745CrossRefPubMed

20.

O’Connor TP, van der Kooy D (1988) Enrichment of a vasoactive neuropeptide (calcitonin gene related peptide) in the trigeminal sensory projection to the intracranial arteries. J Neurosci 8:2468–2476CrossRefPubMedPubMedCentral

21.

Uddman R, Edvinsson L, Ekman R, Kingman T, McCulloch J (1985) Innervation of the feline cerebral vasculature by nerve fibers containing calcitonin gene-related peptide: trigeminal origin and co-existence with substance P. Neurosci Lett 62:131–136. https://doi.org/10.1016/0304-3940(85)90296-4 CrossRefPubMed

22.

Edvinsson L, Gulbenkian S, Barroso CP, Cunha e Sá M, Polak JM, Mortensen A, Jørgensen L, Jansen-Olesen I (1998) Innervation of the human middle meningeal artery: immunohistochemistry, ultrastructure, and role of endothelium for vasomotility. Peptides 19:1213–1225. https://doi.org/10.1016/S0196-9781(98)00066-7 CrossRefPubMed

23.

Eftekhari S, Warfvinge K, Blixt FW, Edvinsson L (2013) Differentiation of nerve fibers storing CGRP and CGRP receptors in the peripheral trigeminovascular system. J Pain 14:1289–1303. https://doi.org/10.1016/j.jpain.2013.03.010 CrossRefPubMed

24.

Jansen I, Uddman R, Ekman R, Olesen J, Ottosson A, Edvinsson L (1992) Distribution and effects of neuropeptide Y, vasoactive intestinal peptide, substance P, and calcitonin gene-related peptide in human middle meningeal arteries: comparison with cerebral and temporal arteries. Peptides 13:527–536. https://doi.org/10.1016/0196-9781(92)90084-G CrossRefPubMed

25.

Messlinger K, Hanesch U, Baumgärtel M, Trost B, Schmidt RF (1993) Innervation of the dura mater encephali of cat and rat: ultrastructure and calcitonin gene-related peptide-like and substance P-like immunoreactivity. Anat Embryol (Berl) 188:219–237CrossRef

26.

Keller JT, Marfurt CF (1991) Peptidergic and serotoninergic innervation of the rat dura mater. J Comp Neurol 309:515–534. https://doi.org/10.1002/cne.903090408 CrossRefPubMed

27.

Uddman R, Hara H, Edvinsson L (1989) Neuronal pathways to the rat middle meningeal artery revealed by retrograde tracing and immunocytochemistry. J Auton Nerv Syst 26:69–75. https://doi.org/10.1016/0165-1838(89)90109-4 CrossRefPubMed

28.

Goadsby PJ, Edvinsson L, Ekman R (1988) Release of vasoactive peptides in the extracerebral circulation of humans and the cat during activation of the trigeminovascular system. Ann Neurol 23:193–196. https://doi.org/10.1002/ana.410230214 CrossRefPubMed

29.

Williamson D, Hargreaves R, Hill R, Shepheard S (1997) Sumatriptan inhibits neurogenic vasodilation of dural blood vessels in the anaesthetized rat—intravital microscope studies. Cephalalgia 17:525–531. https://doi.org/10.1046/j.1468-2982.1997.1704525.x CrossRefPubMed

30.

Brain SD, Williams TJ, Tippins JR, Morris HR, MacIntyre I (1985) Calcitonin gene-related peptide is a potent vasodilator. Nature 313:54–56CrossRefPubMed

31.

Edvinsson L (2004) Blockade of CGRP receptors in the intracranial vasculature: a new target in the treatment of headache. Cephalalgia 24:611–622. https://doi.org/10.1111/j.1468-2982.2003.00719.x CrossRefPubMed

32.

Jansen I, Uddman R, Hocherman M, Ekman R, Jensen K, Olesen J, Srienholm P, Edvinsson L (1986) Localization and effects of neuropeptide Y, vasoactive intestinal polypeptide, substance P, and calcitonin gene-related peptide in human temporal arteries. Ann Neurol 20:496–501. https://doi.org/10.1002/ana.410200409 CrossRefPubMed

33.

Petersen KA, Nilsson E, Olesen J, Edvinsson L (2005) Presence and function of the calcitonin gene-related peptide receptor on rat pial arteries investigated in vitro and in vivo. Cephalalgia 25:424–432. https://doi.org/10.1111/j.1468-2982.2005.00869.x CrossRefPubMed

34.

Schebesch KM, Herbst A, Bele S, Schödel P, Brawanski A, Stoerr EM, Lohmeier A, Kagerbauer SM, Martin J, Proescholdt M (2013) Calcitonin-gene related peptide and cerebral vasospasm. J Clin Neurosci 20:584–586. https://doi.org/10.1016/j.jocn.2012.07.006 CrossRefPubMed

35.

Russell FA, King R, Smillie S-J, Kodji X, Brain SD (2014) Calcitonin gene-related peptide: physiology and pathophysiology. Physiol Rev 94:1099–1142. https://doi.org/10.1152/physrev.00034.2013 CrossRefPubMedPubMedCentral

36.

Smillie SJ, Brain SD (2011) Calcitonin gene-related peptide (CGRP) and its role in hypertension. Neuropeptides 45:93–104. https://doi.org/10.1016/j.npep.2010.12.002 CrossRefPubMed

37.

Labruijere S, Compeer MG, van den Bogaerdt AJ, van den Brink AM, De Mey JG, Danser AH, Batenburg WW (2013) Long-lasting physiological antagonism of calcitonin gene-related peptide towards endothelin-1 in rat mesenteric arteries and human coronary arteries. Eur J Pharmacol 720:303–309. https://doi.org/10.1016/j.ejphar.2013.10.012 CrossRefPubMed

38.

Brain SD, Grant AD (2004) Vascular actions of calcitonin gene-related peptide and adrenomedullin. Physiol Rev 84:903–934. https://doi.org/10.1152/physrev.00037.2003 CrossRefPubMed

39.

Mai TH, Wu J, Diedrich A, Garland EM, Robertson D (2014) Calcitonin gene-related peptide (CGRP) in autonomic cardiovascular regulation and vascular structure. J Am Soc Hypertens 8:286–296. https://doi.org/10.1016/j.jash.2014.03.001 CrossRefPubMedPubMedCentral

40.

Franco-Cereceda A (1991) Calcitonin gene-related peptide and human epicardial coronary arteries: presence, release and vasodilator effects. Br J Pharmacol 102:506–510CrossRefPubMedPubMedCentral

41.

Deng PY, Li YJ (2005) Calcitonin gene-related peptide and hypertension. Peptides 26:1676–1685. https://doi.org/10.1016/j.peptides.2005.02.002 CrossRefPubMed

42.

Luu TN, Dashwood MR, Chester AH, Muddle JR, Yacoub MH (1995) Calcitonin gene-related peptide in healthy and atheromatous human epicardial coronary arteries. Function and receptor characterization. J Vasc Res 32:93–99CrossRefPubMed

43.

Katori T, Hoover DB, Ardell JL, Helm RH, Belardi DF, Tocchetti CG, Forfia PR, Kass DA, Paolocci N (2005) Calcitonin gene-related peptide in vivo positive inotropy is attributable to regional sympatho-stimulation and is blunted in congestive heart failure. Circ Res 96:234–243. https://doi.org/10.1161/01.RES.0000152969.42117.ca CrossRefPubMed

44.

Li J, Wang DH (2005) Development of angiotensin II-induced hypertension: role of CGRP and its receptor. J Hypertens 23:113–118CrossRefPubMed

45.

Sekiguchi N, Kanatsuka H, Sato K, Wang Y, Akai K, Komaru T, Takishima T (1994) Effect of calcitonin gene-related peptide on coronary microvessels and its role in acute myocardial ischemia. Circulation 89:366–374CrossRefPubMed

46.

Lind H, Edvinsson L (2002) Enhanced vasodilator responses to calcitonin gene-related peptide (CGRP) in subcutaneous arteries in human hypertension. J Hum Hypertens 16:53–59. https://doi.org/10.1038/sj.jhh.1001294 CrossRefPubMed

47.

Schuler B, Rieger G, Gubser M, Arras M, Gianella M, Vogel O, Jirkof P, Cesarovic N, Klohs J, Jakob P, Brock M, Gorr TA, Baum O, Hoppeler H, Samillan-Soto V, Gassmann M, Fischer JA, Born W, Vogel J (2014) Endogenous α-calcitonin-gene-related peptide promotes exercise-induced, physiological heart hypertrophy in mice. Acta Physiol 211:107–121. https://doi.org/10.1111/apha.12244 CrossRef

48.

Dvorakova MC, Kruzliak P, Rabkin SW (2014) Role of neuropeptides in cardiomyopathies. Peptides 61:1–6. https://doi.org/10.1016/j.peptides.2014.08.004 CrossRefPubMed

49.

Li J, Levick SP, DiPette DJ, Janicki JS, Supowit SC (2013) Alpha-calcitonin gene-related peptide is protective against pressure overload-induced heart failure. Regul Pept 185:20–28. https://doi.org/10.1016/j.regpep.2013.06.008 CrossRefPubMed

50.

Duan L, Lei H, Zhang Y, Wan B, Chang J, Feng Q, Huang W (2016) Calcitonin gene-related peptide improves hypoxia-induced inflammation and apoptosis via nitric oxide in H9c2 cardiomyoblast cells. Cardiology 133:44–53. https://doi.org/10.1159/000439123 CrossRefPubMed

51.

Li YJ, Peng J (2002) The cardioprotection of calcitonin gene-related peptide-mediated preconditioning. Eur J Pharmacol 442:173–177CrossRefPubMed

52.

Zhou FW, Li YJ, Lu R, Deng HW (1999) Protection of calcitonin gene-related peptide-mediated preconditioning against coronary endothelial dysfunction induced by reperfusion in the isolated rat heart. Life Sci 64:1091–1097CrossRefPubMed

53.

Marongiu E, Crisafulli A (2014) Cardioprotection acquired through exercise: the role of ischemic preconditioning. Curr Cardiol Rev 10:336–348. https://doi.org/10.2174/1573403X10666140404110229 CrossRefPubMedPubMedCentral

54.

Holzmann B (2013) Antiinflammatory activities of CGRP modulating innate immune responses in health and disease. Curr Protein Pept Sci 14:268–274CrossRefPubMed

55.

Assas BM, Pennock JI, Miyan JA (2014) Calcitonin gene-related peptide is a key neurotransmitter in the neuro-immune axis. Front Neurosci 8(23). https://doi.org/10.3389/fnins.2014.00023

56.

Hay DL, Garelja ML, Poyner DR, Walker CS (2018) Update on the pharmacology of calcitonin/CGRP family of peptides: IUPHAR review 25. Br J Pharmacol 175:3–17. https://doi.org/10.1111/bph.14075 CrossRefPubMed

57.

Eftekhari S, Edvinsson L (2011) Calcitonin gene-related peptide (CGRP) and its receptor components in human and rat spinal trigeminal nucleus and spinal cord at C1-level. BMC Neurosci 12:112. https://doi.org/10.1186/1471-2202-12-112 CrossRefPubMedPubMedCentral

58.

Eftekhari S, Salvatore CA, Calamari A, Kane SA, Tajti J, Edvinsson L (2010) Differential distribution of calcitonin gene-related peptide and its receptor components in the human trigeminal ganglion. Neuroscience 169:683–696. https://doi.org/10.1016/j.neuroscience.2010.05.016 CrossRefPubMed

59.

Storer RJ, Akerman S, Goadsby PJ (2004) Calcitonin gene-related peptide (CGRP) modulates nociceptive trigeminovascular transmission in the cat. Br J Pharmacol 142:1171–1181. https://doi.org/10.1038/sj.bjp.0705807 CrossRefPubMedPubMedCentral

60.

Li J, Vause CV, Durham PL (2008) Calcitonin gene-related peptide stimulation of nitric oxide synthesis and release from trigeminal ganglion glial cells. Brain Res 1196:22–32. https://doi.org/10.1016/j.brainres.2007.12.028 CrossRefPubMedPubMedCentral

61.

Csati A, Tajti J, Tuka B, Edvinsson L, Warfvinge K (2012) Calcitonin gene-related peptide and its receptor components in the human sphenopalatine ganglion - interaction with the sensory system. Brain Res 1435:29–39. https://doi.org/10.1016/j.brainres.2011.11.058 CrossRefPubMed

62.

Deutch AY, Roth RH (1987) Calcitonin gene-related peptide in the ventral tegmental area: selective modulation of prefrontal cortical dopamine metabolism. Neurosci Lett 74:169–174. https://doi.org/10.1016/0304-3940(87)90144-3 CrossRefPubMed

63.

Akram H, Miller S, Lagrata S, Hyam J, Jahanshahi M, Hariz M, Matharu M, Zrinzo L (2016) Ventral tegmental area deep brain stimulation for refractory chronic cluster headache. Neurology 86:1676–1682. https://doi.org/10.1212/WNL.0000000000002632 CrossRefPubMedPubMedCentral

64.

Bailey R, Walker C, Ferner A, Loomes K, Prijic G, Halim A, Whiting L, Phillips A, Hay D (2012) Pharmacological characterization of rat amylin receptors: implications for the identification of amylin receptor subtypes. Br J Pharmacol 166:151–167. https://doi.org/10.1111/j.1476-5381.2011.01717.x CrossRefPubMedPubMedCentral

65.

Hay DL, Christopoulos G, Christopoulos A, Poyner DR, Sexton PM (2005) Pharmacological discrimination of calcitonin receptor: receptor activity-modifying protein complexes. Mol Pharmacol 67:1655–1665. https://doi.org/10.1124/mol.104.008615 CrossRefPubMed

66.

Bailey RJ, Hay DL (2006) Pharmacology of the human CGRP1 receptor in cos 7 cells. Peptides 27:1367–1375. https://doi.org/10.1016/J.PEPTIDES.2005.11.014 CrossRefPubMed

67.

Hay DL, Walker CS (2017) CGRP and its receptors. Headache 57:625–636. https://doi.org/10.1111/head.13064 CrossRefPubMed

68.

Oliver KR, Wainwright A, Edvinsson L, Pickard JD, Hill RG (2002) Immunohistochemical localization of calcitonin receptor-like receptor and receptor activity-modifying proteins in the human cerebral vasculature. J Cereb Blood Flow Metab 22:620–629. https://doi.org/10.1097/00004647-200205000-00014 CrossRefPubMed

69.

Baskaya MK, Suzuki Y, Anzai M, Seki Y, Saito K, Takayasu M, Shibuya M, Sugita K (1995) Effects of adrenomedullin, calcitonin gene-related peptide, and amylin on cerebral circulation in dogs. J Cereb Blood Flow Metab 15:827–834. https://doi.org/10.1038/jcbfm.1995.103 CrossRefPubMed

70.

Sams A, Knyihár-Csillik E, Engberg J, Szok D, Tajti J, Bodi I, Edvinsson L, Vécsei L, Jansen-Olesen I (2000) CGRP and adrenomedullin receptor populations in human cerebral arteries: in vitro pharmacological and molecular investigations in different artery sizes. Eur J Pharmacol 408:183–193. https://doi.org/10.1016/S0014-2999(00)00781-0 CrossRefPubMed

71.

Petersen KA, Birk S, Kitamura K, Olesen J (2009) Effect of adrenomedullin on the cerebral circulation: relevance to primary headache disorders. Cephalalgia 29:23–30. https://doi.org/10.1111/j.1468-2982.2008.01695.x CrossRefPubMed

72.

Walker CS, Eftekhari S, Bower RL, Wilderman A, Insel PA, Edvinsson L, Waldvogel HJ, Jamaluddin MA, Russo AF, Hay DL (2015) A second trigeminal CGRP receptor: function and expression of the AMY1 receptor. Ann Clin Transl Neurol 2:595–608. https://doi.org/10.1002/acn3.197 CrossRefPubMedPubMedCentral

73.

Goadsby PJ, Edvinsson L (1994) Human in vivo evidence for trigeminovascular activation in cluster headache. Neuropeptide changes and effects of acute attacks therapies. Brain 117(Pt 3):427–434CrossRefPubMed

74.

Fanciullacci M, Alessandri M, Figini M, Geppetti P, Michelacci S (1995) Increase in plasma calcitonin gene-related peptide from the extracerebral circulation during nitroglycerin-induced cluster headache attack. Pain 60:119–123CrossRefPubMed

75.

Fanciullacci M, Alessandri M, Sicuteri R, Marabini S (1997) Responsiveness of the trigeminovascular system to nitroglycerine in cluster headache patients. Brain 120(Pt 2):283–288CrossRefPubMed

76.

Strecker T, Dux M, Messlinger K (2002) Increase in meningeal blood flow by nitric oxide - interaction with calcitonin gene-related peptide receptor and prostaglandin synthesis inhibition. Cephalalgia 22:233–241. https://doi.org/10.1046/j.1468-2982.2002.00356.x CrossRefPubMed

77.

Neeb L, Anders L, Euskirchen P, Hoffmann J, Israel H, Reuter U (2015) Corticosteroids alter CGRP and melatonin release in cluster headache episodes. Cephalalgia 35:317–326. https://doi.org/10.1177/0333102414539057 CrossRefPubMed

78.

Vollesen ALH, Snoer A, Beske RP, Guo S, Hoffmann J, Jensen RH, Ashina M (2018) Effect of infusion of calcitonin gene-related peptide on cluster headache attacks: a randomized clinical trial. JAMA Neurol 75:1187–1197. https://doi.org/10.1001/jamaneurol.2018.1675 CrossRefPubMedPubMedCentral

79.

Hou M, Kanje M, Longmore J, Tajti J, Uddman R, Edvinsson L (2001) 5-HT1B and 5-HT1D receptors in the human trigeminal ganglion: co-localization with calcitonin gene-related peptide, substance P and nitric oxide synthase. Brain Res 909:112–120. https://doi.org/10.1016/S0006-8993(01)02645-2 CrossRefPubMed

80.

Durham PL, Russo AF (1999) Regulation of calcitonin gene-related peptide secretion by a serotonergic antimigraine drug. J Neurosci 19:3423–3429. https://doi.org/10.1523/jneurosci.0647-06.2006 CrossRefPubMedPubMedCentral

81.

Durham PL, Russo AF (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 23:807–815. https://doi.org/10.1002/ajmg.10195 CrossRefPubMedPubMedCentral

82.

Leone M (2018) Evidence mounts for anti-CGRP treatment in cluster headache. Nat Rev Neurol 14:636–637CrossRefPubMed

83.

May A, Bahra A, Büchel C, Frackowiak RSJ, Goadsby PJ (2000) PET and MRA findings in cluster headache and MRA in experimental pain. Neurology. 55:1328–1335. https://doi.org/10.1212/WNL.55.9.1328 CrossRefPubMed

84.

Messlinger K (2018) The big CGRP flood - sources, sinks and signalling sites in the trigeminovascular system. J Headache Pain 19(22):22. https://doi.org/10.1186/s10194-018-0848-0 CrossRefPubMedPubMedCentral

85.

Martinez JM, Goadsby PJ, Dodick D, Bardos JN, Oakes TMM, Millen BA, Zhou C, Dowsett SA, Aurora SK, Yang JY, Conley RR (2018) Study CGAL: a placebo-controlled study of galcanezumab in patients with episodic cluster headache: results from the 8-week double-blind treatment phase. J Headache Pain 19:20CrossRef

Titel: Anti-CGRP in cluster headache therapy
verfasst von: Luca Giani
Alberto Proietti Cecchini
Massimo Leone
Publikationsdatum: 28.02.2019
Verlag: Springer International Publishing
Erschienen in: Neurological Sciences / Ausgabe Sonderheft 1/2019
Print ISSN: 1590-1874
Elektronische ISSN: 1590-3478
DOI: https://doi.org/10.1007/s10072-019-03786-7

Leitlinien kompakt für die Neurologie

Mit medbee Pocketcards sicher entscheiden.

^{Seit 2022 gehört die medbee GmbH zum Springer Medizin Verlag}

Kostenlos registrieren

Neu im Fachgebiet Neurologie

Niedriger diastolischer Blutdruck erhöht Risiko für schwere kardiovaskuläre Komplikationen

25.04.2024 Hypotonie Nachrichten

Wenn unter einer medikamentösen Hochdrucktherapie der diastolische Blutdruck in den Keller geht, steigt das Risiko für schwere kardiovaskuläre Ereignisse: Darauf deutet eine Sekundäranalyse der SPRINT-Studie hin.

Frühe Alzheimertherapie lohnt sich

25.04.2024 AAN-Jahrestagung 2024 Nachrichten

Ist die Tau-Last noch gering, scheint der Vorteil von Lecanemab besonders groß zu sein. Und beginnen Erkrankte verzögert mit der Behandlung, erreichen sie nicht mehr die kognitive Leistung wie bei einem früheren Start. Darauf deuten neue Analysen der Phase-3-Studie Clarity AD.

Viel Bewegung in der Parkinsonforschung

25.04.2024 Parkinson-Krankheit Nachrichten

Neue arznei- und zellbasierte Ansätze, Frühdiagnose mit Bewegungssensoren, Rückenmarkstimulation gegen Gehblockaden – in der Parkinsonforschung tut sich einiges. Auf dem Deutschen Parkinsonkongress ging es auch viel um technische Innovationen.

Demenzkranke durch Antipsychotika vielfach gefährdet

23.04.2024 Demenz Nachrichten

Wenn Demenzkranke aufgrund von Symptomen wie Agitation oder Aggressivität mit Antipsychotika behandelt werden, sind damit offenbar noch mehr Risiken verbunden als bislang angenommen.

Update Neurologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Springer Medizin

Abstract

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Sonderheft 1/2019

The role of electrophysiological investigations of masticatory muscles in patients with persistent idiopathic facial pain

Cluster headache: insights from resting-state functional magnetic resonance imaging

Migraine in childhood: an organic, biobehavioral, or psychosomatic disorder?

Metacognition and theory of mind in children with migraine and children with internalizing disorders

Prevention, education and counselling: the worldwide role of the community pharmacist as an epidemiological sentinel of headaches