Headache Care Center, Springfield, MO, USA.
Headache. 2014 Feb;54(2):269-77. doi: 10.1111/head.12250. Epub 2013 Oct 22.
To determine if baseline/interictal saliva calcitonin gene-related peptide (CGRP) levels would be lower in subjects with chronic migraine receiving onabotulinumtoxinA compared with those receiving saline.
CGRP is considered central to the pathogenesis of episodic migraine, but its relationship to chronic migraine is less understood. OnabotulinumtoxinA is an effective treatment for chronic migraine and has been demonstrated to inhibit the vesicular release of CGRP.
This was an exploratory, randomized, placebo-controlled, crossover pilot study of 20 subjects that received onabotulinumtoxinA and saline injection (placebo). The amount of CGRP in saliva samples collected on a nonheadache or low headache day, and prior to and after treatment of a headache exacerbation was measured. Daily headache records, medications, and response to treatment were recorded in a diary.
A decrease in baseline/interictal saliva CGRP levels for subjects receiving onabotulinumtoxinA from 39.4 ± 7.5 pg CGRP/mg total protein after the first month to 25.5 ± 4.1 pg after the third month was observed. However, this difference did not reach significance nor was it significant when compared to the saline treatment. There was a reduction in the number of headache days for both onabotulinumtoxinA and saline over baseline throughout the active phases of the study. However, there was no statistical difference in headache days between groups. Subjects with a greater than 50% response to onabotulinumtoxinA had better 2-hour pain relief with acute treatment than non-responders to onabotulinumtoxinA or saline.
While CGRP levels were not elevated during a migraine attack in chronic migraine subjects as has been reported in episodic migraine, there was an overall decrease in the baseline/interictal levels in response to onabotulinumtoxinA.
确定与接受生理盐水相比，接受肉毒毒素 A 治疗的慢性偏头痛患者在基线/发作间期唾液降钙素基因相关肽（CGRP）水平是否较低。
CGRP 被认为是发作性偏头痛发病机制的关键，但对其与慢性偏头痛的关系了解较少。肉毒毒素 A 是治疗慢性偏头痛的有效方法，已证明其可抑制 CGRP 的囊泡释放。
这是一项探索性、随机、安慰剂对照、交叉先导研究，共纳入 20 名受试者，他们接受了肉毒毒素 A 和生理盐水注射（安慰剂）。在非头痛或低头痛日以及头痛加重治疗前后，测量唾液样本中 CGRP 的含量。每日头痛记录、药物使用情况以及治疗反应均记录在日记中。
接受肉毒毒素 A 的患者基线/发作间期唾液 CGRP 水平从第一个月后的 39.4±7.5 pg CGRP/mg 总蛋白下降到第三个月后的 25.5±4.1 pg，这一变化具有统计学意义。然而，与生理盐水治疗相比，这一差异无统计学意义。在研究的活跃阶段，肉毒毒素 A 和生理盐水治疗组的头痛天数均较基线减少。然而，两组之间的头痛天数无统计学差异。与生理盐水相比，对肉毒毒素 A 反应大于 50%的患者在急性治疗时具有更好的 2 小时疼痛缓解效果。
虽然慢性偏头痛患者在偏头痛发作期间 CGRP 水平并未升高，如发作性偏头痛患者中所报道的那样，但肉毒毒素 A 治疗后总体上基线/发作间期水平下降。
