CGRP receptor antagonist olcegepant (BIBN4096BS) does not prevent glyceryl trinitrate-induced migraine.
There is a striking similarity between the migraine-provoking effect of the nitric oxide (NO) donor glyceryl trinitrate (GTN) and that of calcitonin gene-related peptide (CGRP). We tested the hypothesis that NO releases CGRP to cause the delayed migraine attack after GTN.


METHODS
In a double-blind-cross-over study, 13 migraine without aura (MO) patients were administered GTN 0.5 µg/kg/minute for 20 minutes and subsequently BIBN4096BS (olcegepant) 10 mg or placebo. Headache scores and development of MO were followed for 24 hours.


RESULTS
MO developed in seven of 13 with olcegepant and in nine of 13 with placebo (p=0.68). The headache scores were similar after the two treatments (p=0.58). Thus CGRP receptor blockade did not prevent GTN-induced migraine.


CONCLUSIONS
The present study indicates that NO does not induce migraine by liberating CGRP. The most likely explanation for our findings is that CGRP has its effect higher than NO in the cascade of events leading to MO attacks.
Department of Neurology, Danish Headache Center, Denmark. tvedskov@dadlnet.dk
J F
JF
Tvedskov
P
P
Tfelt-Hansen
K A
KA
Petersen
L T
LT
Jensen
J
J
Olesen
D000328:Adult; D000077221:Calcitonin Gene-Related Peptide Receptor Antagonists; D018592:Cross-Over Studies; D004151:Dipeptides / Q000494:pharmacology*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008881:Migraine Disorders / Q000139:chemically induced / Q000188:drug therapy* / Q000378:metabolism; D005996:Nitroglycerin / Q000009:adverse effects; D010879:Piperazines; D011799:Quinazolines / Q000494:pharmacology*; D014665:Vasodilator Agents / Q000009:adverse effects
D000077221:Calcitonin Gene-Related Peptide Receptor Antagonists; D004151:Dipeptides; D010879:Piperazines; D011799:Quinazolines; D014665:Vasodilator Agents; D005996:Nitroglycerin; C406305:olcegepant