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Is there a role of calcitonin gene-related peptide in cortical spreading depression mechanisms?- argument con.

作者信息

Melo-Carrillo Agustin

机构信息

Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, CLS-624-E, 3 Blackfan Circle, Boston, MA, 02215, USA.

Harvard Medical School, Boston, MA, USA.

出版信息

J Headache Pain. 2025 Apr 28;26(1):91. doi: 10.1186/s10194-025-02012-4.


DOI:10.1186/s10194-025-02012-4
PMID:40295929
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12036166/
Abstract

Cortical spreading depression (CSD) is a wave of neuronal and glial depolarization followed by suppressed neural activity, thought to underlie migraine aura. While Calcitonin Gene-Related Peptide (CGRP) is well established in migraine pathophysiology, its role in CSD remains uncertain. This comment evaluates evidence suggesting that CGRP is not directly involved in CSD initiation or propagation but may contribute to nociceptive activation associated with migraine. While some studies report CGRP-related effects on CSD susceptibility, methodological limitations raise concerns about their interpretation. Electrophysiological data indicate that CGRP does not influence the ionic mechanisms driving CSD. However, CGRP plays a key role in sensitizing nociceptive neurons, and CGRP-targeting drugs effectively modulate migraine pain without altering CSD dynamics. Clinical findings further suggest that peripheral CGRP inhibition reduces headache burden, potentially allowing the brain to recover from chronic pain states. In conclusion, while CGRP is integral to migraine pain modulation, its direct involvement in CSD appears minimal, highlighting distinct pathways for aura and headache pathophysiology.

摘要

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引用本文的文献

[1]
Is there a role of calcitonin gene-related peptide in cortical spreading depression mechanisms?- Argument pro.

J Headache Pain. 2025-4-28

本文引用的文献

[1]
Mapping the migraine: Intracranial recording of cortical spreading depression in migraine with aura.

Headache. 2025-4

[2]
Meningeal lymphatic vessel dysfunction driven by CGRP signaling causes migraine-like pain in mice.

J Clin Invest. 2024-8-1

[3]
Meningeal lymphatic CGRP signaling governs pain via cerebrospinal fluid efflux and neuroinflammation in migraine models.

J Clin Invest. 2024-5-14

[4]
Novel insight into atogepant mechanisms of action in migraine prevention.

Brain. 2024-8-1

[5]
Peripherally acting anti-CGRP monoclonal antibodies alter cortical gray matter thickness in migraine patients: A prospective cohort study.

Neuroimage Clin. 2023

[6]
Galcanezumab effects on incidence of headache after occurrence of triggers, premonitory symptoms, and aura in responders, non-responders, super-responders, and super non-responders.

J Headache Pain. 2023-3-16

[7]
Pre-treatment non-ictal cephalic allodynia identifies responders to prophylactic treatment of chronic and episodic migraine patients with galcanezumab: A prospective quantitative sensory testing study (NCT04271202).

Cephalalgia. 2023-3

[8]
Atogepant - an orally-administered CGRP antagonist - attenuates activation of meningeal nociceptors by CSD.

Cephalalgia. 2022-8

[9]
Fremanezumab and its isotype slow propagation rate and shorten cortical recovery period but do not prevent occurrence of cortical spreading depression in rats with compromised blood-brain barrier.

Pain. 2020-5

[10]
Fluorescently-labeled fremanezumab is distributed to sensory and autonomic ganglia and the dura but not to the brain of rats with uncompromised blood brain barrier.

Cephalalgia. 2020-3

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