Calcitonin Gene Related Peptide (CGRP) in migraine pathophysiology

There is compelling evidence that CGRP plays an important role in migraine pathophysiology and thus representing an interesting target for therapeutic applications. Available research demonstrates that CGRP as well as other pro inflammatory mediators are being released from an activated trigeminal ganglion, which in turn leads to increase in further synthesis of CGRP. Elevated plasma concentration of CGRP during migraine headache attacks and CGRP level normalization or reduction with treatment has been established and is being discussed in this article.

Medication Overuse Headache Basics

Medication overuse headache (MOH) is a secondary headache disorder that is due to excessive use of acute medications. This usually happens when patient with pre-existing primary headache disease most commonly chronic migraine exceed the threshold for using acute medications for temporary symptomatic relief of their headache. MOH can also occur with withdrawal of acute medication triggering an attack or worsening of pre-existing primary headache disorder. This is also known as rebound headache. This typically leads to increase in headache days and escalating doses of acute medications. If headache worsens with amplified use of acute medications or improves once they are discontinued the diagnosis is supported.

Sphenopalatine ganglion stimulation in cluster headaches

Cluster headaches are characterized by severe debilitating pain which is often refractory to treatment. It is described in the ICDH-3 Beta headache criteria as consisting of attacks of severe, strictly unilateral pain which is orbital, supraorbital, temporal or in any combination of these sites, lasting 15-180 minutes and occurring from once every other day to eight times a day. The sphenopalatine ganglion (SPG) has been implicated in the pathophysiology of cluster headache, and therefore has been targeted to treat cluster headaches. In an article published in Cephalalgia, authors Láinez Marti reviewed the published literature on SPG stimulation and cluster headaches. An SPG stimulator is a device inserted by a minimally invasive procedure in which a neurostimulator directly and reversibly stimulates the area of the SPG. They found evidence that demonstrated that SPG stimulation is a safe and effective treatment for chronic refractory cluster headache patients, effective in both acute at- tacks and as a preventative treatment.

Read more here:http://journals.sagepub.com/doi/full/10.1177/0333102416644968