Cranial autonomic symptoms and response to monoclonal antibodies targeting the Calcitonin gene-related peptide pathway: A real-world study
Source : https://www.frontiersin.org/articles/10.3389/fneur.2022.973226/full
ObjectiveCranial autonomic symptoms (CAS), including conjunctival injection, tearing, nasal congestion or rhinorrhea, eyelid edema, miosis or ptosis, and forehead or facial sweating ipsilateral to headache, are often reported by patients with migraine during headache attacks. CAS is a consequence of the activation of the trigeminovascular system, which is the target of monoclonal antibodies acting on the CGRP pathway.
Conclusions: In our cohort, the presence of CAS was associated with a greater response to monoclonal antibodies targeting the CGRP pathway. CAS could be a clinical marker of trigeminovascular activation and thus be related to a better response to CGRP treatments.
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Huma Sheikh, CEO, NY Neurology Medicine, PCOctober 18, 2022This is a great article.
Examining the correlation between salivary cytokine concentrations and CRP in people experiencing social-cognitive stress
Source : https://www.tandfonline.com/doi/abs/10.1080/01616412.2022.2126681?journalCode=yner20
ABSTRACT The study aims to determine the relationship of migraine and chronic tension-type headache (TTHs) with alterations in the salivary markers of inflammation . - The prospective study involved 75 patients . The concentrations of inflammatory markers (CRP, IL-1 β, and IL-6) in migraine and chronic TTH patients were determined in distinct time points: headache-free period (interictal period), during headache (ictal period), day after headache attack.
Conclusions: The relationship of CRP, IL1-β, and IL-6 concentrations with migraine and chronic TTH has been established. No statistically significant differences were found in the dynamics between migraine and chronic TTH groups. There was a direct correlation of migraine and chronic TTH with anxiety and depression.
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Alterations in metabolic flux in migraine and the translational relevance - The Journal of Headache and Pain
Source : https://thejournalofheadacheandpain.biomedcentral.com/articles/10.1186/s10194-022-01494-w
Background Migraine is a highly prevalent disorder with significant economical and personal burden. Despite the development of effective therapeutics, the causes which precipitate migraine attacks remain elusive. Clinical studies have highlighted altered metabolic flux and mitochondrial function in patients. In vivo animal experiments can allude to the metabolic mechanisms which may underlie migraine susceptibility.
Conclusion: Migraine susceptibility may be underpinned by impaired metabolism resulting in depleted energy stores and altered neuronal function. This review discusses both clinical and in vivo studies which provide evidence of altered metabolic flux which contribute toward pathophysiology. It also reviews the translational relevance of animal studies in identifying targets of biomarker or therapeutic development.
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Huma Sheikh, CEO, NY Neurology Medicine, PCOctober 06, 2022I completely agree that there are likely metabolic changes that are occuring.
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Migraine ConnectOctober 04, 2022Key Points
• Source: The Journal of Headache and Pain
• Conclusion: “Migraine susceptibility may be underpinned by impaired metabolism resulting in depleted energy stores and altered neuronal function. This review discusses both clinical and in vivo studies which provide evidence of altered metabolic flux which contribute toward pathophysiology. It also reviews the translational relevance of animal studies in identifying targets of biomarker or therapeutic development.”
• The pathophysiology of migraine could involve mitochondrial and metabolic deficits. Migraine patients exhibit mitochondrial disorders and structural and biochemical impairments in the electron transfer chain.
• CGRP is a major nociceptive peptide involved in migraine and exhibits a reciprocal relationship with multiple metabolic pathways such as glucose and lipid use.
• The effects of CGRP antagonism on insulin function remains to be elucidated. In animal models, CGRP antagonism improves oral glucose tolerance.
• Headache could be an adverse effect of diabetes. Pramlintide, an amylin receptor agonist, is approved for diabetes treatment in the U.S. and off-target effects could activate the trigeminovascular system.
• “It is still uncertain as to whether metabolic deficits result in excessive CGRP-mediated nociception or vice versa. Attributing metabolic perturbations exclusively to migraine may be difficult, since common migraine comorbidities also feature some metabolic alterations such as obesity and depression. However, both clinical and in vivo evidence suggests that an imbalance between energetic demand and supply may contribute towards migraine pathology. Therefore, perturbation of metabolic pathways which exacerbate this imbalance may be the basis for the metabolic component of migraine,” the authors wrote.
Gestational exposure to erenumab-The outcome of three pregnancies - PubMed
Source : https://pubmed.ncbi.nlm.nih.gov/36151771/
Erenumab is a monoclonal antibody (mAb) approved for the preventive treatment of migraine. While preclinical studies on calcitonin gene-related peptide mAbs did not identify any reproductive toxicity, pregnant and breastfeeding...
Conclusion/Relevance: No plausible explanation relates the mechanism of action of erenumab and the serious complication that occurred in one patient. Continuous follow-up and reporting of all exposures are encouraged to gather safety data on pregnant and nursing women and on the development of the newborns. So far, immediately stopping the drug is advised and may contribute to decreasing the potential risks.
Assessment and characteristics of Erenumab therapy on migraine management
Source : https://www.sciencedirect.com/science/article/pii/S1319016422001621?via=ihub
Migraine is one of the neurological diseases that have a negative impact on subjects' productivity and daily activity of patients. Introducing monoclonal antibodies as a valuable option for resolving the persistent problem of migraine is still under investigation. The current study aimed to evaluate the efficacy and safety profile related to Erenumab.
Conclusion: Using Erenumab therapy showed a great beneficial impact regarding the reduction of migraine-related disabilities. COVID-19 was related to the increased severity of migraine attacks.
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