CGRP, Migraine, and Brain MRI in CADASIL: A Pilot Study

Authors

• Paul L. Durham, Missouri State UniversityFollow
• Eric D. Goldstein, The Warren Alpert Medical School
• Neethu Gopal, Departments of Neurology
• Mohammed K. Badi, Departments of Neurology
• David O. Hodge, Mayo Clinic in Jacksonville, Florida
• Adam De Havenon, Yale School of Medicine
• Patrick Glover, Departments of Neurology
• Josephine F. Huang, Departments of Neurology
• Michelle P. Lin, Departments of Neurology
• Hediyeh Baradaran, Departments of Radiology
• Jennifer J. Majersik, University of Utah School of Medicine
• James F. Meschia, Departments of Neurology

Abstract

Background: Migraine is associated with neuroimaging differences in cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL). However, it is unknown if migraine-related disability (MRD) or if calcitonin gene-related peptide (CGRP), a vasoactive peptide important in migraine pathology, have radiographic implications. The aims of this study were to identify whether MRD or interictal serum CGRP levels impacted neuroimaging findings for those with CADASIL. Materials and Methods: A cross-sectional analysis was performed. The primary outcomes were neuroimaging differences associated with MRD among those with migraine or interictal serum CGRP levels of those with and without migraine. MRD was defined by 2 migraine disability scales (Migraine Disability Assessment, Headache Impact Test-6). Retrospective brain magnetic resonance imaging was reviewed (average 1.7 ± 2.0 y before enrollment). Rank-sum and ?²tests were used. Results: Those with migraine (n=25, vs. n=14 without) were younger [median 49 (25 to 82) y vs. 60 (31 to 82) y, P<0.007], had fewer cerebral microbleeds (0 to 31 vs. 0 to 50, P=0.02) and less frequently had anterior temporal lobe T2 hyperintensities [68% (17/25) vs 100% (14/14), P=0.02]. MRD scale outcomes had no significant radiographic associations. Interictal serum CGRP did not differ (migraine: n=18, 27.0±9.6 pg/mL vs. no migraine: n=10, 26.8±15.7 pg/mL, P=0.965). Conclusions: Migraine may forestall microangiopathy in CADASIL, though possibly independent of severity as measured by MRD. Interictal serum CGRP did not differ in our cohort suggesting CGRP may not be vital to migraine pathophysiology in CADASIL. Larger studies are needed to account for age differences.

Department(s)

Biology

Document Type

Article

DOI

10.1097/NRL.0000000000000478

Keywords

CADASIL, CGRP, migraine, MRI

Publication Date

7-19-2023

Recommended Citation

Durham, Paul L.; Goldstein, Eric D.; Gopal, Neethu; Badi, Mohammed K.; Hodge, David O.; De Havenon, Adam; Glover, Patrick; Huang, Josephine F.; Lin, Michelle P.; Baradaran, Hediyeh; Majersik, Jennifer J.; and Meschia, James F., "CGRP, Migraine, and Brain MRI in CADASIL: A Pilot Study" (2023). Faculty Scholarship. 559.
https://bearworks.missouristate.edu/articles00/559

Journal Title

Neurologist