In support, there is a clear association between the head pain and the release of the neuropeptide calcitonin gene-related peptide (CGRP) from the trigeminovascular system. In cluster headache there is, in addition, release of the parasympathetic neuropeptide vasoactive intestinal peptide (VIP) that is coupled to facial vasomotor symptoms. Triptan administration, activating the 5-HT
1B/1D receptors, causes the headache to subside and the levels of neuropeptides to normalise, in part through presynaptic inhibition of the cranial sensory nerves. These data suggest a central role for sensory and parasympathetic mechanisms in the pathophysiology of primary headaches. The positive clinical trial with a CGRP receptor antagonist offers a new promising way of treatment.
Lars Edvinssona, , and Rolf Uddmanb
aDepartment of Internal Medicine, University Hospital, S-221 85 Lund, Sweden
bDepartment of Otorhinolaryngology, Malmö University Hospital, Malmö, Sweden
Accepted 8 September 2004.
Available online 18 November 2004.