Cephalalgia : an international journal of headache最新文献

{"title":"No additive effect of combining sumatriptan and olcegepant in the GTN mouse model of migraine.","authors":"Charlotte Ernstsen,&nbsp;Sarah L Christensen,&nbsp;Jes Olesen,&nbsp;David M Kristensen","doi":"10.1177/0333102420963857","DOIUrl":"https://doi.org/10.1177/0333102420963857","url":null,"abstract":"<p><strong>Introduction: </strong>Despite recent advances in migraine treatment there is a need for therapies with higher clinical efficacy and/or fewer side effects. Triptans (5-HT_1B/1D/1F agonists) are essential in the present treatment regime and gepants (CGRP-receptor antagonists) are recognized as effective in acute migraine treatment. Triptans and gepants have different mechanisms of action and here we tested the hypothesis that a combination of these drugs (sumatriptan and olcegepant) would result in an additive effect.</p><p><strong>Methods: </strong>Using the validated glyceryl trinitrate mouse model of migraine, we initially tested dose-response relationships of sumatriptan (0.1, 0.3, and 0.6 mg/kg IP) and olcegepant (0.25, 0.50, and 1.0 mg/kg IP) to find suitable high and low doses. Subsequently, we performed a combination study of the two drugs with a low and a high dose. All experiments were vehicle (placebo) controlled and blinded.</p><p><strong>Results: </strong>Sumatriptan significantly reduced glyceryl trinitrate-induced allodynia (F(4,54) = 13.51, <i>p</i> < 0.0001) at all doses. Olcegepant also reduced glyceryl trinitrate-induced allodynia (F(4,53) = 16.11, <i>p</i> < 0.0001) with the two higher doses being significantly effective. Combining 0.50 mg/kg olcegepant with 0.1 or 0.6 mg/kg sumatriptan did not have any improved effect compared to either drug alone (<i>p</i> > 0.50 on all days) in our mouse model.</p><p><strong>Conclusion: </strong>Combining olcegepant and sumatriptan did not have an additive effect compared to single-drug treatment in this study. Triptan-gepant combinations will therefore most likely not improve migraine treatment. Nevertheless, further studies are necessary, and combinations should also be examined in patients with migraine.</p>","PeriodicalId":195255,"journal":{"name":"Cephalalgia : an international journal of headache","volume":" ","pages":"329-339"},"PeriodicalIF":4.9,"publicationDate":"2021-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/0333102420963857","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38493889","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence and characteristics of cough headache in a Chinese respiratory clinic.","authors":"Yimo Zhang,&nbsp;Xin Zhao,&nbsp;Yan Wang,&nbsp;Zhao Dong,&nbsp;Shengyuan Yu","doi":"10.1177/0333102420970187","DOIUrl":"https://doi.org/10.1177/0333102420970187","url":null,"abstract":"<p><strong>Background: </strong>To evaluate the prevalence, predictive factors and clinical characteristics of cough headache in our respiratory clinic and to investigate the coexistence between cough headache, migraine and tension-type headache.</p><p><strong>Method: </strong>We consecutively investigated patients referred to our respiratory clinic with complaints of cough and selected patients with cough headaches to complete a structured interview and examination.</p><p><strong>Results: </strong>Six hundred and seventy-nine patients with cough were studied and 122 patients were diagnosed with cough headache. The prevalence of cough headache was 18.0% in these coughing patients. According to multivariate analysis, being of an age between 31-50 years was a risk factor for cough headache (OR 2.0). Cough headache was associated with cough severity: Compared with the mild group, the moderate group (OR 2.3) and the severe group (OR 3.3) were more vulnerable to cough headache. Headache severity had a positive correlation with cough severity (ρ = 0.301, <i>p</i> = 0.028), age (ρ = 0.199, <i>p</i> = 0.029), and headache duration (ρ = 0.242, <i>p</i> = 0.008). In cough headache patients, 30.3% had tension-type headache and 10.7% had migraine in the preceding year.</p><p><strong>Conclusions: </strong>Cough headache is not rare in respiratory clinics and the characteristics are somewhat different from those in headache clinics. An age of between 31-50 years and cough severity were risk factors for cough headache. Headache severity was related to cough severity, age and headache duration.</p>","PeriodicalId":195255,"journal":{"name":"Cephalalgia : an international journal of headache","volume":" ","pages":"366-374"},"PeriodicalIF":4.9,"publicationDate":"2021-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/0333102420970187","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38592939","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pain perception in women with menstrually-related migraine.","authors":"Katie M Linstra,&nbsp;Khatera Ibrahimi,&nbsp;Daphne S van Casteren,&nbsp;Marieke Jh Wermer,&nbsp;Gisela M Terwindt,&nbsp;Antoinette MaassenVanDenBrink","doi":"10.1177/0333102420966977","DOIUrl":"https://doi.org/10.1177/0333102420966977","url":null,"abstract":"<p><strong>Background: </strong>Cyclic hormonal fluctuations influence migraine incidence and severity. Previously, we described reduced menstrual cyclicity in estradiol levels and dermal blood flow reaction to capsaicin in female migraineurs. It is unclear whether pain perception in women with migraine is influenced by the menstrual cycle.</p><p><strong>Methods: </strong>Women with menstrually-related migraine (n = 14), healthy age-matched controls (n = 10) and postmenopausal women (n = 15) were asked to grade trigeminal and non-trigeminal painful stimuli on a numeric pain rating scale on menstrual cycle day 19-21 (mid-luteal) and day 1-2 (early follicular).</p><p><strong>Results: </strong>In women with menstrually-related migraine, trigeminal pain remained low throughout the cycle. Controls showed increased trigeminal pain during the mid-luteal phase compared to the early follicular phase. Changes throughout the cycle were significantly different between women with MRM and controls.</p><p><strong>Conclusion: </strong>The compromised menstrual cyclicity of pain perception in women with menstrually-related migraine parallels our earlier findings on estradiol levels and dermal blood flow.</p>","PeriodicalId":195255,"journal":{"name":"Cephalalgia : an international journal of headache","volume":" ","pages":"417-421"},"PeriodicalIF":4.9,"publicationDate":"2021-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/0333102420966977","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38610599","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Randomized, controlled trial of lasmiditan over four migraine attacks: Findings from the CENTURION study.","authors":"Messoud Ashina,&nbsp;Uwe Reuter,&nbsp;Timothy Smith,&nbsp;Judith Krikke-Workel,&nbsp;Suzanne R Klise,&nbsp;Sonja Bragg,&nbsp;Erin G Doty,&nbsp;Sherie A Dowsett,&nbsp;Qun Lin,&nbsp;John H Krege","doi":"10.1177/0333102421989232","DOIUrl":"https://doi.org/10.1177/0333102421989232","url":null,"abstract":"<p><strong>Background: </strong>We present findings from the multicenter, double-blind Phase 3 study, CENTURION. This study was designed to assess the efficacy of and consistency of response to lasmiditan in the acute treatment of migraine across four attacks.</p><p><strong>Methods: </strong>Patients were randomized 1:1:1 to one of three treatment groups - lasmiditan 200 mg; lasmiditan 100 mg; or a control group that received placebo for three attacks and lasmiditan 50 mg for either the third or fourth attack. The primary endpoints were pain freedom at 2 h (first attack) and pain freedom at 2 h in ≥2/3 attacks. Secondary endpoints included pain relief, sustained pain freedom and disability freedom. Statistical testing used a logistic regression model and graphical methodology to control for multiplicity.</p><p><strong>Results: </strong>Overall, 1471 patients treated ≥1 migraine attack with the study drug. Both primary endpoints were met for lasmiditan 100 mg and 200 mg (<i>p</i> < 0.001). All gated secondary endpoints were met. The incidence of treatment-emergent adverse events (TEAEs) was highest during the first attack. The most common TEAEs with lasmiditan were dizziness, paresthesia, fatigue, and nausea; these were generally mild or moderate in severity.</p><p><strong>Conclusions: </strong>These results confirm the early and sustained efficacy of lasmiditan 100 mg and 200 mg and demonstrate consistency of response across multiple attacks.<b>Trial Registration Number:</b> NCT03670810.</p>","PeriodicalId":195255,"journal":{"name":"Cephalalgia : an international journal of headache","volume":" ","pages":"294-304"},"PeriodicalIF":4.9,"publicationDate":"2021-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/0333102421989232","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25331731","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Refractory short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing responsive to anti-calcitonin gene-related peptide monoclonal antibodies: A case report.","authors":"Gabriel Bsteh,&nbsp;Christian Bsteh,&nbsp;Gregor Broessner","doi":"10.1177/0333102420954558","DOIUrl":"https://doi.org/10.1177/0333102420954558","url":null,"abstract":"<p><strong>Background: </strong>Short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) is a rare but severely disabling variant within the spectrum of trigeminal autonomic cephalalgia lacking evidence-based treatment.</p><p><strong>Case: </strong>We report a case of chronic SUNCT in a 67-year-old man refractory to various guideline-conforming treatment attempts responding excellently to galcanezumab.</p><p><strong>Conclusions: </strong>This case report indicates that monoclonal antibodies against calcitonin gene-related peptide, specifically galcanezumab, might be a treatment option for SUNCT warranting further investigation.</p>","PeriodicalId":195255,"journal":{"name":"Cephalalgia : an international journal of headache","volume":" ","pages":"127-130"},"PeriodicalIF":4.9,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/0333102420954558","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38328497","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A phase 2, randomized, double-blind, placebo-controlled trial of AMG 301, a pituitary adenylate cyclase-activating polypeptide PAC1 receptor monoclonal antibody for migraine prevention.","authors":"Messoud Ashina,&nbsp;David Doležil,&nbsp;Jo H Bonner,&nbsp;Lifen Zhou,&nbsp;Jan Klatt,&nbsp;Hernan Picard,&nbsp;Daniel D Mikol","doi":"10.1177/0333102420970889","DOIUrl":"https://doi.org/10.1177/0333102420970889","url":null,"abstract":"<p><strong>Objective: </strong>To assess the safety and efficacy of AMG 301, an inhibitor of the pituitary adenylate cyclase-activating polypeptide (PACAP)-1 (PAC1) receptor, for prevention of migraine.</p><p><strong>Methods: </strong>In a double-blind trial, patients were randomized 4:3:3 to placebo, AMG 301 210 mg every 4 weeks, or AMG 301 420 mg every 2 weeks for 12 weeks. Effect on monthly migraine days and other secondary measures were assessed over weeks 9-12. Safety and tolerability were assessed.</p><p><strong>Results: </strong>Of 343 randomized patients (mean age, 41.8-42.5 years), the majority were women (85.4-90.4%), white (94.1-96.2%), and had episodic migraine (62.5-67.9%). A total of 305 patients completed treatment (placebo, n = 124; AMG 301 210 mg, n = 94; AMG 301 420 mg, n = 87). Least squares mean reduction at week 12 in monthly migraine days from baseline was -2.5 (0.4) days for placebo and -2.2 (0.5) days for both AMG 301 treatment groups. No difference between AMG 301 and placebo on any measure of efficacy was observed; mean (95% confidence interval) treatment difference versus placebo for monthly migraine days for AMG 301 210 mg, 0.3 (-0.9 to 1.4); AMG 301 420 mg, 0.3 (-0.9 to 1.4). The incidence of adverse events was similar across groups.</p><p><strong>Conclusion: </strong>AMG 301 offered no benefit over placebo for migraine prevention; further studies may be necessary to fully understand the role of PACAP isoforms and its receptors in migraine pathophysiology.</p><p><strong>Study registration: </strong>ClinicalTrials.gov: NCT03238781.</p>","PeriodicalId":195255,"journal":{"name":"Cephalalgia : an international journal of headache","volume":" ","pages":"33-44"},"PeriodicalIF":4.9,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/0333102420970889","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38737884","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Board Walk - January 2021.","authors":"Henrik Winther Schytz,&nbsp;Mi Ji Lee","doi":"10.1177/0333102420981848","DOIUrl":"https://doi.org/10.1177/0333102420981848","url":null,"abstract":"","PeriodicalId":195255,"journal":{"name":"Cephalalgia : an international journal of headache","volume":" ","pages":"131-132"},"PeriodicalIF":4.9,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/0333102420981848","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38783091","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reversion from chronic migraine to episodic migraine: A new outcome measure.","authors":"Shuu-Jiun Wang,&nbsp;Jr-Wei Wu","doi":"10.1177/0333102420974004","DOIUrl":"https://doi.org/10.1177/0333102420974004","url":null,"abstract":"Migraine can be easily separated into two subtypes based on headache frequency; that is, episodic migraine (EM) and chronic migraine (CM). Over the years, our understanding of migraine chronification has largely improved (1). Patients with CM are more likely to have depression, anxiety, asthma, and circulation problems than those with EM (2). Cutaneous allodynia, non-cephalic pain, fibromyalgia, and chronic low back pain are also more common in CM (3–5). Also, neuroimaging studies on CM demonstrate structural changes in brain regions involved in pain processing and affective regulation (6,7). Compared with EM, CM is associated with higher disabilities, socioeconomic burdens, and medical costs (1,2,7). It is estimated that the annual incidence of transition from EM to CM is 2.5–3.1% (8,9), and the risk factors of migraine chronification include overuse of acute medications, ineffective acute treatment, obesity, depression, and stressful life events (7). Considering the huge disease burden of CM, the goals of treatment for EM should include preventing transformation to CM. In contrast, the American Migraine Prevalence and Prevention (AMPP) study reported that about 26% patients with CM reverted to EM over 2 years (10). The results of the Chronic Migraine Epidemiology and Outcomes (CaMEO) study showed 49.9% reverted to EM during 3-month follow-up (5). One earlier study of ours also showed that up to 65% of patients remitted from chronic daily headache (mainly CM) in two years (11). Seemingly, CM is not a stable diagnosis during follow-up, although these epidemiological studies did not mention how many participants were on migraine preventive treatment. However, this outcome measure “reversion from CM to EM” has never been tested in clinical trials. Studies focusing on CM treatment are not as common as on EM, and the results are less optimal (12,13). Before the era of CGRP monoclonal antibodies (mAbs), only topiramate and onabotulinumtoxinA demonstrated efficacy in CM (14–16); and the latter was effective only in CM but not in EM (16–18). In real-world practice, traditional preventive medications for EM are commonly prescribed to patients with CM (18). CGRP mAbs showed positive results as prophylactic treatment for CM (13). However, as for EM, the clinical trials for CM also used mean reduction of monthly migraine days and proportions of 50% reduction of monthly migraine days as their co-primary endpoints (13,19). In this volume of Cephalalgia, Lipton et al. (20) conducted a post-hoc analysis of erenumab, a human monoclonal antibody blocking the CGRP receptor, for the preventive treatment of CM to test, for the first time, this new outcome measure – reversion from CM to EM. It is defined as&lt; 45 headache days per 12 weeks in this study. They found 54.1% of patients with CM reverted to EM in the first 12 weeks after treatment, and 96.8% of these patients maintained the status quo of EM for further 64 weeks. Patients who did not revert to EM through the","PeriodicalId":195255,"journal":{"name":"Cephalalgia : an international journal of headache","volume":" ","pages":"3-5"},"PeriodicalIF":4.9,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/0333102420974004","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38612659","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reversion from chronic migraine to episodic migraine following treatment with erenumab: Results of a <i>post-hoc</i> analysis of a randomized, 12-week, double-blind study and a 52-week, open-label extension.","authors":"Richard B Lipton,&nbsp;Stewart J Tepper,&nbsp;Stephen D Silberstein,&nbsp;David Kudrow,&nbsp;Messoud Ashina,&nbsp;Uwe Reuter,&nbsp;David W Dodick,&nbsp;Feng Zhang,&nbsp;Gregory A Rippon,&nbsp;Sunfa Cheng,&nbsp;Daniel D Mikol","doi":"10.1177/0333102420973994","DOIUrl":"https://doi.org/10.1177/0333102420973994","url":null,"abstract":"<p><strong>Objective: </strong>To determine reversion rates from chronic migraine to episodic migraine during long-term erenumab treatment.</p><p><strong>Methods: </strong>A daily headache diary was completed during the 12-week, double-blind treatment phase of a placebo-controlled trial comparing erenumab 70 mg, 140 mg, and placebo, and weeks 1-12, 21-24, 37-40, and 49-52 of the open-label treatment phase. Chronic migraine to episodic migraine reversion rates were assessed over the double-blind treatment phase; <i>persistent reversion</i> to episodic migraine over 24 weeks (double-blind treatment phase through the first 12 weeks in the open-label treatment phase), <i>long-term persistent reversion</i> to episodic migraine over 64 weeks (double-blind treatment phase plus open-label treatment phase); <i>delayed reversion</i> to episodic migraine through the first 12 weeks of the open-label treatment phase among patients remaining in chronic migraine during the double-blind treatment phase.</p><p><strong>Results: </strong>In the double-blind treatment phase, 53.1% (95% confidence interval: 47.8-58.3) of 358 erenumab-treated completers had reversion to episodic migraine; monthly reversion rates to episodic migraine were typically higher among patients receiving 140 mg versus 70 mg. Among 181 completers (receiving erenumab for 64 weeks), 98 (54.1% [95% confidence interval: 46.6-61.6]) had reversion to episodic migraine during the double-blind treatment phase; of those, 96.9% (95% confidence interval: 91.3-99.4) had persistent reversion to episodic migraine, 96.8% (95% confidence interval: 91.1-99.3) of whom had long-term persistent reversion to episodic migraine. Delayed reversion to episodic migraine occurred in 36/83 (43.4% [95% confidence interval: 32.5-54.7]) patients; of these, 77.8% (95% confidence interval: 60.9-89.9) persisted in reversion through week 64.</p><p><strong>Conclusions: </strong>Patients with reversion to episodic migraine at week 12 will likely persist as episodic migraine with longer-term erenumab; others may achieve delayed reversion to episodic migraine.<b>Clinical trial registration:</b> URL: https://www.clinicaltrials.gov. Unique identifier: NCT02066415.</p>","PeriodicalId":195255,"journal":{"name":"Cephalalgia : an international journal of headache","volume":" ","pages":"6-16"},"PeriodicalIF":4.9,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/0333102420973994","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38669514","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Baseline tear fluid CGRP is elevated in active cluster headache patients as long as they have not taken attack abortive medication.","authors":"Katharina Kamm,&nbsp;Andreas Straube,&nbsp;Ruth Ruscheweyh","doi":"10.1177/0333102420949858","DOIUrl":"https://doi.org/10.1177/0333102420949858","url":null,"abstract":"<p><strong>Background: </strong>Calcitonin gene-related peptide plays a key role in cluster headache pathophysiology. It is released from the trigeminal nerve, which also innervates the eye. In this study, we tested if tear fluid calcitonin gene-related peptide measurement detects elevated calcitonin gene-related peptide levels in cluster headache patients compared to controls.</p><p><strong>Methods: </strong>Calcitonin gene-related peptide concentration in tear fluid and plasma of 16 active episodic and 11 chronic cluster headache patients (all outside acute attacks) and 60 controls were assessed using ELISA.</p><p><strong>Results: </strong>Cluster headache patients without use of attack abortive medication in the last 48 h showed significantly elevated tear fluid calcitonin gene-related peptide levels (1.78 ± 1.57 ng/ml, n = 17) compared to healthy controls (0.79 ± 0.74 ng/ml, <i>p</i> = 0.003) and compared to cluster headache patients who had used attack abortive medication in the last 48 h (0.84 ± 1.40 ng/ml, n = 10, <i>p</i> = 0.022). High calcitonin gene-related peptide levels in cluster headache patients were independent of the occurrence of a cluster headache attack in the last 48 hours (no attack: 1.95 ± 1.65 ng/ml, n = 8; attack: 1.63 ± 1.59 ng/ml, n = 9, <i>p</i> = 0.82) as long as no acute medication was used. No significant difference in tear fluid calcitonin gene-related peptide levels between episodic (1.48 ± 1.34 ng/ml) and chronic cluster headache patients (2.21 ± 1.88 ng/ml, <i>p</i> = 0.364) was detected. In contrast to these results in tear fluid, there were no significant group differences in plasma calcitonin gene-related peptide levels.</p><p><strong>Conclusion: </strong>This study shows that active cluster headache patients have increased calcitonin gene-related peptide levels in tear fluid compared to healthy subjects, which are reduced to control levels after intake of attack abortive medication. Calcitonin gene-related peptide measurement in tear fluid is non-invasive, and has the advantage of allowing direct access to calcitonin gene-related peptide released from the trigeminal nerve.</p>","PeriodicalId":195255,"journal":{"name":"Cephalalgia : an international journal of headache","volume":" ","pages":"69-77"},"PeriodicalIF":4.9,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/0333102420949858","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38310449","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}