Triptans and CGRP blockade – impact on the cranial vasculature

• Main Authors: Silvia Benemei, Francesca Cortese, Alejandro Labastida-Ramírez, Francesca Marchese, Lanfranco Pellesi, Michele Romoli, Anne Luise Vollesen, Christian Lampl, Messoud Ashina, On behalf of the School of Advanced Studies of the European Headache Federation (EHF-SAS)
• Format: Article
• Language: English
• Published: BMC 2017-10-01
• Series: The Journal of Headache and Pain
• Subjects: Triptans; Calcitonin gene related peptide – CGRP; Anti-CGRP (receptor) monoclonal antibodies – mAbs; Middle meningeal artery; Middle cerebral arteries; Migraine models
• Online Access: http://link.springer.com/article/10.1186/s10194-017-0811-5

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.