Neuropeptide changes in a case of chronic paroxysmal hemicrania--evidence for trigemino-parasympathetic activation.
Chronic paroxysmal hemicrania (CPH) is a rare headache syndrome of short-lasting attacks of pain, characterized clinically by trigemino-parasympathetic activation. The features of the headache are severe attacks of pain that generally last no more than minutes in association with autonomic activation, such as lacrimation or rhinorrhea. We report a patient fulfilling International Headache Society guidelines for the diagnosis of CPH in whom levels of calcitonin gene-related peptide (CGRP) and vasoactive intestinal polypeptide (VIP) were elevated in the cranial circulation during attacks. Moreover, successful treatment of the problem with indomethacin leads to normalization of the levels of both CGRP and VIP. Given that similar neuropeptide changes are seen in cluster headache the data suggest a shared underlying pathophysiology between CPH and cluster headache.
Institute of Neurology, National Hospital for Neurology and Neurosurgery, London, UK.
P J
PJ
Goadsby
L
L
Edvinsson
D000328:Adult; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D001143:Arousal / Q000187:drug effects / Q000502:physiology; D015740:Calcitonin Gene-Related Peptide / Q000502:physiology; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007213:Indomethacin / Q000627:therapeutic use; D008881:Migraine Disorders / Q000188:drug therapy / Q000235:genetics / Q000503:physiopathology*; D009479:Neuropeptides / Q000502:physiology*; D010275:Parasympathetic Nervous System / Q000187:drug effects / Q000503:physiopathology*; D014276:Trigeminal Nerve / Q000187:drug effects / Q000503:physiopathology*; D014660:Vasoactive Intestinal Peptide / Q000502:physiology
D000894:Anti-Inflammatory Agents, Non-Steroidal; D009479:Neuropeptides; D014660:Vasoactive Intestinal Peptide; D015740:Calcitonin Gene-Related Peptide; D007213:Indomethacin