CGRP, Migraine, and Menstruation in Women 2024
CGRP inhibitors like Aimovig (erenumab), Ajovy (fremanezumab) given by subcutaneous injection for migraine prevention, and Nurtec (rimegepant) given as an oral 75 mg tablet for acute therapy are extremely effective for migraine treatment.
A drug like Aimovig routinely reduce migraine attacks by 50-70% and sometimes by 100%. Nurtec is effective for about 21% of patients.
CGRP therefore has been proven to be an important chemical released by the migraine process. Migraine is improved when CGRP is blocked or inhibited.
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Migraine affects 27% of women and is notorious for causing disability due to the severe headache pain, sensitivity to light, sound, and odors, the need to be down, and nausea and vomiting. Migraine is the 3rd most common cause of medical disability.
Fifty to Sixty percent of women have menstrual migraine attacks, which are usually their most severe, debilitating, long duration migraine attacks they experience.
This is an article by Britt Talley Daniel MD, retired member of the American Academy of Neurology, Migraine textbook author, Podcaster, YouTube video producer, and Blogger.
Read my article on “Menstrual headache:” on my blog www.doctormigraine.com.
It has been found with recent scientific investigation that estrogen sex hormones modulate calcitonin gene-related peptide (CGRP) release in the trigeminovascular system during a migraine headache. Higher estrogen levels were associated with higher CGRP levels and more severe migraine symptoms.
Who were the scientific investigators who did this work?
B Raffaelli, E Storch, LH Overeem, et al, writing on “Sex Hormones and Calcitonin Gene–Related Peptide in Women With Migraine,” in Neurology 2023 Apr 25;100(17):e1825-e1835 were the investigators. The investigators stated,
In conclusion, our data suggest hormone-dependent changes in CGRP concentrations in female patients with EM. The elevated CGRP release from the trigeminovascular system following hormonal fluctuations could help to explain a higher susceptibility for migraine in female people who menstruate. The lower CGRP tear fluid concentrations under hormonal contraception in patients with migraine could be associated with an altered migraine susceptibility under hormonal therapy and should be further investigated in a longitudinal design.
K Kamm, A Straube, R Ruscheweyh writing on “Calcitonin gene-related peptide levels in tear fluid are elevated in migraine patients compared to healthy controls.” in Cephalalgia. 2019 Oct;39(12):1535-1543. The author’s reported,
Conclusion: To the best of our knowledge, this study shows, for the first time, increased CGRP tear fluid levels in migraine patients compared to healthy subjects. Detection of calcitonin gene-related peptide in tear fluid is non-invasive, and likely allows a more direct access to CGRP released from the trigeminal nerve than plasma sampling.
Take home message-When estrogen increases, so does CGRP output, and the migraine experience worsens. Hopefully improved migraine therapy will come from this information.
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Britt Talley Daniel MD
