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Review
. 2017 Oct 10;18(1):103.
doi: 10.1186/s10194-017-0811-5.

Triptans and CGRP blockade - impact on the cranial vasculature

Silvia Benemei  1 , Francesca Cortese  2 , Alejandro Labastida-Ramírez  3 , Francesca Marchese  4 , Lanfranco Pellesi  5 , Michele Romoli  6 , Anne Luise Vollesen  7 , Christian Lampl  8 , Messoud Ashina  9 ; School of Advanced Studies of the European Headache Federation (EHF-SAS)
Affiliations
Review

Triptans and CGRP blockade - impact on the cranial vasculature

Silvia Benemei et al. J Headache Pain. .

Abstract

The trigeminovascular system plays a key role in the pathophysiology of migraine. The activation of the trigeminovascular system causes release of various neurotransmitters and neuropeptides, including serotonin and calcitonin gene-related peptide (CGRP), which modulate pain transmission and vascular tone. Thirty years after discovery of agonists for serotonin 5-HT1B and 5-HT1D receptors (triptans) and less than fifteen after the proof of concept of the gepant class of CGRP receptor antagonists, we are still a long way from understanding their precise site and mode of action in migraine. The effect on cranial vasculature is relevant, because all specific anti-migraine drugs and migraine pharmacological triggers may act in perivascular space. This review reports the effects of triptans and CGRP blocking molecules on cranial vasculature in humans, focusing on their specific relevance to migraine treatment.

Keywords: Anti-CGRP (receptor) monoclonal antibodies – mAbs; Calcitonin gene related peptide – CGRP; Magnetic resonance angiography (MRA); Middle cerebral arteries; Middle meningeal artery; Migraine models; Triptans.

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Conflict of interest statement

Competing interests

Prof Messoud Ashina is a consultant or scientific advisor for Allergan, Amgen, Alder, ATI and Eli Lilly, primary investigator for Amgen 20,120,178 (Phase 2), 20,120,295 (Phase 2), 20,130,255 (OLE), 20,120,297 (Phase 3) and GM-11 gamma-Core-R trials, and reports grants from Lundbeck Foundation (R155–2014-171), Research Foundation of the Capital Region of Copenhagen, Danish Council for Independent Research, Medical Sciences and Novo Nordisk Foundation (NNF11OC101433). Other authors have no competing interests.

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Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Effects of sumatriptan and olcegepant on cranial vessels in migraine patients. The intracerebral vessels, the middle cerebral artery (MCA) and the cerebral part of the internal carotid artery (ICAcerebral), are both shown in yellow. The extracerebral artery, the cavernous part of the internal carotid artery (ICAcavernous), is shown in blue. The extracranial vessels, the middle meningeal artery (MMA) and the superficial temporal artery (STA), are both shown in purple. Boxes include description of vessel reactivity during spontaneous and/or CGRP induced attacks as well as vessel response to sumatriptan and/or olcegepant. Imaging modality indicated in parentheses in boxes; magnetic resonance angiography (MRA) or transcranial ultrasound Doppler (Doppler). Image from MRA of healthy volunteer kindly provided by Faisal M Amin
See this image and copyright information in PMC

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