Patients with mild traumatic brain injury have a PTH -post-traumatic headache. It can develop migraine-like persistency due to calcitonin gene-related peptides – CGRP (α- and β-CGRP). This study analyses the role of such peptides in headache incidence and migraine intensity.
The randomized, two-way crossover study highlights CGRP sensitivity in PTH patients. There were 30 subjects in the age group of 18 -65 years. They had persistent PTH after TBI for at least a year. They were randomly grouped for placebo and CGRP infusion. On two separate days, they received 1.5 mcg/min of CGRP or isotonic saline. The outcomes were evaluated using a 12-hour observational period. The difference in migraine or exacerbated headache incidence was calculated. The area under the curve difference scored the headache intensity.
About 21 out of 30 or 70% had exacerbated headaches with migraine-like features after CGRP infusion. In comparison, only 20% or six patients reacted likewise to the placebo. The headline intensity score was calculated after correction for the baseline area under the curve. It was also significantly larger for the CGRP group compared to the placebo group.
The results show that persistent PTH patients are hypersensitive to CGRP. They open up new possibilities for innovative, mechanism-based therapies.
Ref: https://onlinelibrary.wiley.com/doi/10.1002/ana.25915
