Triptan-induced disruption of trigemino-cortical connectivity

Kröger, Inga L; May, Arne

doi:10.1212/wnl.0000000000001610

Cited by 45 publications

(39 citation statements)

References 39 publications

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“…Recently, an neuroimaging study found that triptans (a class of migraine-specific medication) could significant increase the BOLD signal in the trigeminal nuclei in migraine patients compared with placebo or a nonsteroidal anti-inflammatory drug (broad spectrum pain killer) (Kröger and May, 2015). The study further illuminated that the increase in BOLD signal changes after triptan administration could be attributable to an inhibition of the inhibitory action of CGRP on trigeminal neurons in the brainstem, and concluded that a specific functional inhibition of trigemino-cortical projections might be one of the reasons that triptans, unlike pain killers, act specifically on migraine but not pain (Kröger and May, 2015).…”

Section: Discussionmentioning

confidence: 99%

“…The study further illuminated that the increase in BOLD signal changes after triptan administration could be attributable to an inhibition of the inhibitory action of CGRP on trigeminal neurons in the brainstem, and concluded that a specific functional inhibition of trigemino-cortical projections might be one of the reasons that triptans, unlike pain killers, act specifically on migraine but not pain (Kröger and May, 2015). Therefore, we speculate that verum acupuncture might also work through the CGRP system to achieve treatment effects.…”

Section: Discussionmentioning

confidence: 99%

“…In the brainstem, the descending modulation of the TCC nociceptive signals originate mainly from the periaqueductal gray (PAG) and the rostral ventromedial medulla (RVM) (Akerman et al, 2011). The TCC/RVM (ascending input/descending modulation) imbalance hypothesis, based on animal models, is increasingly supported by human brain imaging studies in migraine patients (Weiller et al, 1995, Stankewitz and May, 2011, Stankewitz et al, 2011, Kröger and May, 2015). For instance, in a positron emission tomography study (Weiller et al, 1995), Weiller and colleagues found that only the cerebral blood flow increase in the brainstem (including PAG, RVM, etc.)…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Acupuncture modulates the abnormal brainstem activity in migraine without aura patients

Zeng

Yin

et al. 2017

NeuroImage: Clinical

108

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Migraine is a common neurological disease with a high prevalence and unsatisfactory treatment options. The specific pathophysiological mechanisms of migraine remain unclear, which restricts the development of effective treatments for this prevalent disorder. The aims of this study were to 1) compare the spontaneous brain activity differences between Migraine without Aura (MwoA) patients and healthy controls (HCs), using amplitude of low-frequency fluctuations (ALFF) calculation method, and 2) explore how an effective treatment (verum acupuncture) could modulate the ALFF of MwoA patients. One hundred MwoA patients and forty-six matched HCs were recruited. Patients were randomized to four weeks' verum acupuncture, sham acupuncture, and waiting list groups. Patients had resting state BOLD-fMRI scan before and after treatment, while HCs only had resting state BOLD-fMRI scan at baseline. Headache intensity, headache frequency, self-rating anxiety and self-rating depression were used for clinical efficacy evaluation. Compared with HCs, MwoA patients showed increased ALFF in posterior insula and putamen/caudate, and reduced ALFF in rostral ventromedial medulla (RVM)/trigeminocervical complex (TCC). After longitudinal verum acupuncture treatment, the decreased ALFF of the RVM/TCC was normalized in migraine patients. Verum acupuncture and sham acupuncture have different modulation effects on ALFF of RVM/TCC in migraine patients. Our results suggest that impairment of the homeostasis of the trigeminovascular nociceptive pathway is involved in the neural pathophysiology of migraines. Effective treatments, such as verum acupuncture, could help to restore this imbalance.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Acupuncture modulates the abnormal brainstem activity in migraine without aura patients

Zeng

Yin

et al. 2017

NeuroImage: Clinical

108

View full text Add to dashboard Cite

show abstract

“…Hence, peripheral release of CGRP (which induces vasodilatation) into the trigeminovascular system is regulated by several mechanisms of neuromodulation at the neurovascular junction and almost all these systems and receptors are also modulating the afferent input to the trigeminal nucleus [188]. Examples of the above are the ergots (5-HT 1 , α 2 -adrenergic, and D 2 -like receptor agonists) and triptans (selective 5-HT 1B/1D/1F receptor agonist) [186, 189–191].…”

Section: The Role Of Cgrp On Some Vascular-related Diseasesmentioning

confidence: 99%

Heteroreceptors Modulating CGRP Release at Neurovascular Junction: Potential Therapeutic Implications on Some Vascular-Related Diseases

González‐Hernández

Marichal‐Cancino

Lozano-Cuenca

et al. 2016

BioMed Research International

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Calcitonin gene-related peptide (CGRP) is a 37-amino-acid neuropeptide belonging to the calcitonin gene peptide superfamily. CGRP is a potent vasodilator with potential therapeutic usefulness for treating vascular-related disease. This peptide is primarily located on C- and Aδ-fibers, which have extensive perivascular presence and a dual sensory-efferent function. Although CGRP has two major isoforms (α-CGRP and β-CGRP), the α-CGRP is the isoform related to vascular actions. Release of CGRP from afferent perivascular nerve terminals has been shown to result in vasodilatation, an effect mediated by at least one receptor (the CGRP receptor). This receptor is an atypical G-protein coupled receptor (GPCR) composed of three functional proteins: (i) the calcitonin receptor-like receptor (CRLR; a seven-transmembrane protein), (ii) the activity-modifying protein type 1 (RAMP1), and (iii) a receptor component protein (RCP). Although under physiological conditions, CGRP seems not to play an important role in vascular tone regulation, this peptide has been strongly related as a key player in migraine and other vascular-related disorders (e.g., hypertension and preeclampsia). The present review aims at providing an overview on the role of sensory fibers and CGRP release on the modulation of vascular tone.

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“…For example, inadequate regulation of the autonomic nervous system (ANS) (Ebinger et al, 2006, Geraud and Donnet, 2013, Melek et al, 2007), derangement of serotonin metabolism (Dussor, 2014, Hoffmann and Goadsby, 2014, Vollbracht and Rapoport, 2014), insensitive reaction to reduced oxygen in the vasculature and tissue (Friberg et al, 1994, Lacombe et al, 1992, Raddant and Russo, 2014), disruption of the normal pain pathways (Kroger and May, 2015), peculiar platelet metabolism (Danese et al, 2014, Gawel and Rose, 1982, Hanington, 1989), neurogenic inflammation (Tajti et al, 2015) and etc. (Alstadhaug, 2014).…”

Section: Introductionmentioning

confidence: 99%

Resting-state fMRI study of acute migraine treatment with kinetic oscillation stimulation in nasal cavity

Wang

Hallin

et al. 2016

NeuroImage: Clinical

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Kinetic oscillatory stimulation (KOS) in the nasal cavity is a non-invasive cranial nerve stimulation method with promising efficacy for acute migraine and other inflammatory disorders. For a better understanding of the underlying neurophysiological mechanisms of KOS treatment, we conducted a resting-state functional magnetic resonance imaging (fMRI) study of 10 acute migraine patients and 10 normal control subjects during KOS treatment in a 3 T clinical MRI scanner. The fMRI data were first processed using a group independent component analysis (ICA) method and then further analyzed with a voxel-wise 3-way ANOVA modeling and region of interest (ROI) of functional connectivity metrics.All migraine participants were relieved from their acute migraine symptoms after 10–20 min KOS treatment and remained migraine free for 3–6 months. The resting-state fMRI result indicates that migraine patients have altered intrinsic functional activity in the anterior cingulate, inferior frontal gyrus and middle/superior temporal gyrus. KOS treatment gave rise to up-regulated intrinsic functional activity for migraine patients in a number of brain regions involving the limbic and primary sensory systems, while down regulating temporally the activity for normal controls in a few brain areas, such as the right dorsal posterior insula and inferior frontal gyrus.The result of this study confirms the efficacy of KOS treatment for relieving acute migraine symptoms and reducing attack frequency. Resting-state fMRI measurements demonstrate that migraine is associated with aberrant intrinsic functional activity in the limbic and primary sensory systems. KOS in the nasal cavity gives rise to the adjustment of the intrinsic functional activity in the limbic and primary sensory networks and restores the physiological homeostasis in the autonomic nervous system.

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Triptan-induced disruption of trigemino-cortical connectivity

Abstract: These data suggest that a specific functional inhibition of trigemino-cortical projections is one of the reasons that triptans, unlike pain killers, act highly specifically on headache and migraine but not pain as such.

Cited by 45 publications

References 39 publications

Acupuncture modulates the abnormal brainstem activity in migraine without aura patients

Acupuncture modulates the abnormal brainstem activity in migraine without aura patients

Heteroreceptors Modulating CGRP Release at Neurovascular Junction: Potential Therapeutic Implications on Some Vascular-Related Diseases

Resting-state fMRI study of acute migraine treatment with kinetic oscillation stimulation in nasal cavity

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