Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan.
Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan; Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan.
Prog Brain Res. 2020;255:123-142. doi: 10.1016/bs.pbr.2020.05.012. Epub 2020 Jun 16.
There is a huge improvement in our understanding of migraine pathophysiology in the past decades. The activation of the trigeminovascular system has been proved to play a key role in migraine. Calcitonin gene-related peptide (CGRP) and CGRP receptors are widely distributed in the trigeminovascular system. The CGRP is expressed on the C-fibers, and the CGRP receptors are distributed on the A-δ fibers of the trigeminal ganglion and nerves. Further studies found elevated serum CGRP level during migraine attacks, and infusion of CGRP can trigger migraine-like attacks, provide more direct evidence of the link between CGRP and migraine attack. Based on these findings, several treatment options have been designed for migraine treatment, including CGRP receptor antagonists (gepants) and monoclonal antibodies targeting CGRP or CGRP receptors. The clinical trials show both gepants and monoclonal antibodies are effective for migraine treatment. In this section, we describe the roles of the trigeminovascular system in migraine, the discovery of CGRP, and the CGRP signaling pathway.
在过去的几十年中，我们对偏头痛发病机制的理解有了巨大的进步。三叉神经系统的激活被证明在偏头痛中起着关键作用。降钙素基因相关肽（CGRP）及其受体广泛分布于三叉神经系统。CGRP 表达于 C 纤维，CGRP 受体分布于三叉神经节和神经的 Aδ纤维上。进一步的研究发现偏头痛发作期间血清 CGRP 水平升高，而 CGRP 的输注可引发偏头痛样发作，为 CGRP 与偏头痛发作之间的联系提供了更直接的证据。基于这些发现，已经设计了几种偏头痛治疗的选择，包括 CGRP 受体拮抗剂（ gepants）和针对 CGRP 或 CGRP 受体的单克隆抗体。临床试验表明， gepants 和单克隆抗体对偏头痛的治疗均有效。在本节中，我们描述了三叉神经系统在偏头痛中的作用、CGRP 的发现以及 CGRP 信号通路。
