Title: Neuropeptides and Other Chemical Mediators, and the Role of Anti-inflammatory Drugs in Primary Headaches
Volume: 9
Issue: 3
Author(s): Mohtashem Samsam, Rafael Covenas, Raheleh Ahangari and Javier Yajeya
Affiliation:
Keywords:
Neuropeptide, Headache, Anti-inflammatory drugs.
Abstract: Primary headaches including the migraine, cluster, and tension headaches are common neurological disorders
which cause pain and disability to the patients. The pathomechanism of migraine is not very well understood however,
current clinical findings indicate a possible primary brain disorder due to activation of the brain and brainstem as triggers
for migraine. The headache phase of migraine may be due to activation of the peripheral nerves including the trigeminal
nerve and others innervating the cranial blood vessels and release of vasoactive substances including the calcitonin generelated
peptides (CGRP), possibly leading to vasodilation and brainstem activation. Several of our studies in an experimental
model of pain using electrical stimulation of the trigeminal ganglion in rats focused on various neuropeptides release
from the peripheral and central trigeminal nerve terminals, however, clinically only the CGRP in migraine and
CGRP and vasoactive intestinal peptide (VIP) in cluster headache were found in patient’s blood. Although several drugs
are used in the treatment of migraine, the non-steroid anti-inflammatory drugs (NSAIDs) and the triptan family of drugs
are the first choice drugs recommended for the treatment of acute migraine headache. Although clinically very few studies
detected other vasoactive/inflammatory molecules in the blood of migraine patients, sensitization of peripheral axons can
involve many inflammatory mediators affecting the peripheral tissue substrates of pain. Moreover, central sensitization in
the trigeminal nucleus can also contribute to additional pain responses. This article reviews neuropeptides and other molecules
involved in primary headaches and major drugs proposed for their treatment in recent years.
