Effect of CGRP inhibitors on interictal cerebral hemodynamics in individuals with migraine

• DOI: 10.3389/fneur.2024.1399792
• Publication Date: 2024-04-30T09:07:28Z
• Authors: Sarah C. Carter; Brett Cucchiara; Navpreet Reehal; Katherine Hamilton; Eric A. Kaiser; Christopher G. Fa...
• Keywords: Transcranial Doppler; Posterior cerebral artery; Anterior cerebral artery; Cerebral autoregulation

Introduction Calcitonin gene-related peptide (CGRP) plays an important role in cerebral vasodilation, so here we aim to quantify the impact of CGRP monoclonal antibody (mAb) therapy on hemodynamics. Methods In 23 patients with chronic and episodic migraine, hemodynamic monitoring was performed (1) prior (2) 3-months into CGRP-mAb therapy. Transcranial Doppler monitored blood flow velocity (CBFv) middle artery (MCA) posterior (PCA), from which cerebrovascular reactivity (CVR) autoregulation (CA; Mx-index ) were calculated. Results CA similar off treatment, MCA ( p = 0.42) PCA 0.72). CVR also unaffected by 0.38) 0.92). CBFv pressure unaffected. The subgroup clinical responders (>50% reduction migraine frequency) exhibited a small MCA-CBFv (6.0 cm/s; IQR: 1.1–12.4; 0.007) PCA-CBFv (8.9 6.9–10.3; 0.04). Discussion Dynamic measures physiology preserved after 3 months therapy, but observed who responded treatment. Subgroup findings should be interpreted cautiously, further investigation may clarify if is dependent degree inhibition or serve as biomarker drug sensitivity.