Annals of Indian Academy of Neurology
LETTER TO THE EDITOR
Year
: 2013  |  Volume : 16  |  Issue : 3  |  Page : 456--457

Author's reply on Pathophysiology of migraine


Peter J Goadsby 
 Headache Group, Department of Neurology, University of California, San Francisco, CA, USA

Correspondence Address:
Peter J Goadsby
Headache Group, Department of Neurology, UCSF Headache Center, 1701 Divisadero St, San Francisco, CA 94115
USA




How to cite this article:
Goadsby PJ. Author's reply on Pathophysiology of migraine.Ann Indian Acad Neurol 2013;16:456-457


How to cite this URL:
Goadsby PJ. Author's reply on Pathophysiology of migraine. Ann Indian Acad Neurol [serial online] 2013 [cited 2020 Jul 11 ];16:456-457
Available from: http://www.annalsofian.org/text.asp?2013/16/3/456/116947


Full Text

Sir,

Thank you for sending along correspondence with regard to a recent review. [1] I am grateful for your correspondents' interest. They make three points:

They comment that citation of data from regional cerebral blood-flow studies [2] to demonstrate a disconnection between migraine pain and vasodilation is insufficient. I would agree. In a wide-reaching review sometimes not all data is cited. It is clear from other work from the same group that superficial temporal artery changes are not seen in migraine triggered by sildenafil, [3] among other examples one could adduce to this pointWith regard to magnetic resonance angiography (MRA) work that does not demonstrate any change in extracranial vessel diameter in migraine, [4] the argument regarding vessel size is somewhat circular. While it is possible smaller vessels are the generator of pain; that has not been demonstrated and directly opposes all the more recent pharmacological data. If small vessels are important why does the non-vascular ditan class work? [5],[6]Your correspondent regards the claim that gepants are without vascular effects as a serious misrepresentation. As your correspondent admits olcegepant is not a vasoconstrictor. [7] The statement made was that olcegepant has no vascular action, not that it stops calcitonin gene-related peptide (CGRP) having vasodilation. Nothing about olcegepant was misrepresented. Your correspondent tendentiously pursues vasodilation with a single example, while ignoring that the gepant data sits with the entirety of the clinical trial literature, conveniently ignoring the ditan data cited above or indeed simple things, such as the data on intravenous aspirin in migraine, [8] again as a non-vascular acute treatment.

May I add on a personal note, whatever reason some may have for developing CGRP receptor antagonists, I can assure you that the first rationale was to look at CGRP release in terms neural mechanisms. [9],[10] Migraine is a brain disorder; [11] the sooner the organ of the disorder receives full focus, the nearer we come to both enhanced understanding and better therapies.

References

1Goadsby PJ. Pathophysiology of migraine. Ann Indian Acad Neurol 2012;15:S15-22.
2Olesen J, Friberg L, Olsen TS, Iversen HK, Lassen NA, Andersen AR, et al. Timing and topography of cerebral blood flow, aura, and headache during migraine attacks. Ann Neurol 1990;28:791-8.
3Kruuse C, Thomsen LL, Birk S, Olesen J. Migraine can be induced by sildenafil without changes in middle cerebral artery diameter. Brain 2003;126:241-7.
4Schoonman GG, van der Grond J, Kortmann C, van der Geest RJ, Terwindt GM, Ferrari MD. Migraine headache is not associated with cerebral or meningeal vasodilatation: A 3T magnetic resonance angiography study. Brain 2008;131:2192-200.
5Ferrari MD, Färkkilä M, Reuter U, Pilgrim A, Davis C, Krauss M, et al. Acute treatment of migraine with the selective 5-HT1F receptor agonist lasmiditan: A randomised proof-of-concept trial. Cephalalgia 2010;30:1170-8.
6Färkkilä M, Diener HC, Géraud G, Láinez M, Schoenen J, Harner N, et al. Efficacy and tolerability of lasmiditan, an oral 5-HT(1F) receptor agonist, for the acute treatment of migraine: A phase 2 randomised, placebo-controlled, parallel-group, dose-ranging study. Lancet Neurol 2012;11:405-13.
7Petersen KA, Birk S, Lassen LH, Kruuse C, Jonassen O, Lesko L, et al. The CGRP-antagonist, BIBN4096BS does not affect cerebral or systemic haemodynamics in healthy volunteers. Cephalalgia 2005;25:139-47.
8Diener HC. Efficacy and safety of intravenous acetylsalicylic acid lysinate compared to subcutaneous sumatriptan and parenteral placebo in the acute treatment of migraine. A double-blind, double-dummy, randomized, multicenter, parallel group study. The ASASUMAMIG Study Group. Cephalalgia 1999;19:581-8.
9Edvinsson L, Ekman R, Goadsby PJ. Vasoactive peptides in the trigeminovascular system of man. Cephalalgia 1987;7:10-2.
10Goadsby PJ, Edvinsson L, Ekman R. Vasoactive peptide release in the extracerebral circulation of humans during migraine headache. Ann Neurol 1990;28:183-7.
11Akerman S, Holland PR, Goadsby PJ. Diencephalic and brainstem mechanisms in migraine. Nat Rev Neurosci 2011;12:570-84.