Department of Medicine, Lund University, Lund, Sweden.
Headache. 2017 May;57 Suppl 2:47-55. doi: 10.1111/head.13081.
The trigeminal ganglion plays a key role in primary headache pathophysiology. Calcitonin gene-related peptide (CGRP) and CGRP receptors are expressed in trigeminal neurons that form C-fibers and A-fibers, respectively. In acute migraine and cluster headache attacks, there is release of CGRP into the cranial venous outflow. In addition, intravenous CGRP can induce migraine-like symptoms in migraine patients. These findings led to the development of anti-migraine therapies that inhibit CGRP action. Currently, CGRP receptor antagonists, the gepants, and monoclonal antibodies towards CGRP and the CGRP receptor are all showing positive relief of acute and chronic migraine in clinical trials. However, there is still much to learn about the role of CGRP and CGRP receptors in headache pathophysiology, the critical anatomical sites, peripheral or central, of anti-CGRP agents, and the potential involvement of CGRP-related peptides and receptors. This review provides a brief history of the discovery of the role of CGRP in migraine and highlights current progress in understanding the complexity of the trigeminovascular pathway and its peptide transmitters.
三叉神经节在原发性头痛发病机制中起关键作用。降钙素基因相关肽 (CGRP) 和 CGRP 受体分别在形成 C 纤维和 A 纤维的三叉神经神经元中表达。在急性偏头痛和丛集性头痛发作期间，CGRP 会被释放到颅外静脉流出中。此外，静脉内 CGRP 可在偏头痛患者中引发偏头痛样症状。这些发现促使开发了抑制 CGRP 作用的抗偏头痛疗法。目前，CGRP 受体拮抗剂、 gepants 以及针对 CGRP 和 CGRP 受体的单克隆抗体，在临床试验中均显示出对急性和慢性偏头痛的缓解作用。然而，关于 CGRP 和 CGRP 受体在头痛发病机制中的作用、抗 CGRP 药物的关键解剖部位（外周或中枢）以及 CGRP 相关肽和受体的潜在参与，仍有许多需要了解。本文简要回顾了 CGRP 在偏头痛中的作用的发现，并强调了当前对三叉血管通路及其肽递质复杂性的理解进展。
