Migraine is the most prevalent of the neurological disorders and can affect the patient throughout the lifetime.
Calcitonin gene-related peptide (CGRP) is a neuropeptide that is expressed in the central and peripheral nervous systems.
It is now 2 decades since it was proposed to be involved in migraine pathophysiology. The cranial sensory system contains
C-fibers storing CGRP and trigeminal nerve activation and acute migraine attacks result in release of CGRP. The
CGRP receptor consists of a complex of calcitonin receptor-like receptor (CLR), receptor activity-modifying protein 1
(RAMP1) and receptor component protein (RCP). At the central synapses in the trigeminal nucleus caudalis, CGRP acts
postjunctionally on second-order neurons to transmit pain signals centrally via brainstem and midbrain to thalamus and
higher cortical pain regions. CLR and RAMPs are widely expressed throughout the brain, in the trigeminal ganglion and
in intracranial arteries. CGRP does not induce neurogenic inflammation or sensitization at peripheral meningeal sites but
relays nociceptive information from trigeminal primary afferent neurons to the second-order neurons in the spinal trigeminal
nucleus neurons. CGRP receptor antagonists have been developed as novel antimigraine drugs and found to be
effective in the treatment of acute migraine attacks. Other ways to stop CGRP activity has been introduced recently
through antibodies against CGRP and the CGRP receptor. While the CGRP receptors are expressed both in the CNS and
at various places related to the trigeminal system the exact site of action for their therapy effect is still unresolved but the
new approaches may resolve this.
Keywords: Migraine, CGRP, telcagepant, trigeminovascular reflex, CGRP receptor antagonists.
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