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Serum CGRP Changes following Ultrasound-Guided Bilateral Greater-Occipital-Nerve Block

Background: Calcitonin-gene-related peptide (CGRP) and CGRP receptors are expressed in trigeminal nerve cells, and treatments targeting CGRP are effective in migraines. For headaches that do not respond to pharmacological treatment, minimally invasive techniques such as greater-occipital-nerve block...

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Autores principales: Abbas, Abdelrahman, Moustafa, Ramez, Shalash, Ali, Haroun, Mahmoud, Amin, Randa, Borham, Sherien, Elsadek, Ahmed, Helmy, Shahinaz
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8883968/
https://www.ncbi.nlm.nih.gov/pubmed/35225886
http://dx.doi.org/10.3390/neurolint14010016
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author Abbas, Abdelrahman
Moustafa, Ramez
Shalash, Ali
Haroun, Mahmoud
Amin, Randa
Borham, Sherien
Elsadek, Ahmed
Helmy, Shahinaz
author_facet Abbas, Abdelrahman
Moustafa, Ramez
Shalash, Ali
Haroun, Mahmoud
Amin, Randa
Borham, Sherien
Elsadek, Ahmed
Helmy, Shahinaz
author_sort Abbas, Abdelrahman
collection PubMed
description Background: Calcitonin-gene-related peptide (CGRP) and CGRP receptors are expressed in trigeminal nerve cells, and treatments targeting CGRP are effective in migraines. For headaches that do not respond to pharmacological treatment, minimally invasive techniques such as greater-occipital-nerve block (GONB) can help relieve the pain and reduce the frequency of headaches. Our study assessed the efficacy of ultrasound-guided greater-occipital-nerve block (USgGONB) in chronic migraines (CM) and its relationship to serum CGRP levels. Methods: Forty chronic migraineurs who underwent bilateral USgGONB using 40 mg triamcinolone and 1 mL lidocaine were recruited and interictal serum CGRP samples were collected immediately before and one month after GONB. The clinical response was evaluated using headache diaries before and one month after USgGONB. The patient response was determined after USgGONB according to the reduction in headache days as a good responder (>50% reduction), poor responder (<50%) or non-responder. Results: Monthly headache days after GONB showed a significant reduction (median, 10 days; range, 8–14.7) compared to before the block (median, 18 days; range, 17–22; p < 0.001). Across all patients, interictal serum CGRP levels after USgGONB were significantly lower than before the block (median, 40 pg/mL (range, 25–60) vs. 145 pg/mL (range, 60–380) (p = 0.001). The pre-treatment interictal CGRP levels showed a significant difference (p = 0.003), as their levels in non-responders (median, 310 pg/mL; interquartile range, 262–350) were significantly higher than those seen in responders, whether poor responders (median, 135 pg/mL; interquartile range, 100–200 pg/mL) or good responders (median, 140 pg/mL; interquartile range, 80–150 pg/mL). Conclusion: the study showed the beneficial effect of USgGONB in chronic migraines that was associated with lowering interictal CGRP levels, implying a potential role for CGRP in the mechanism of action of GONB in CM, and the interictal CGRP level may be used as a predictor for the response to GONB.
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spelling pubmed-88839682022-03-01 Serum CGRP Changes following Ultrasound-Guided Bilateral Greater-Occipital-Nerve Block Abbas, Abdelrahman Moustafa, Ramez Shalash, Ali Haroun, Mahmoud Amin, Randa Borham, Sherien Elsadek, Ahmed Helmy, Shahinaz Neurol Int Article Background: Calcitonin-gene-related peptide (CGRP) and CGRP receptors are expressed in trigeminal nerve cells, and treatments targeting CGRP are effective in migraines. For headaches that do not respond to pharmacological treatment, minimally invasive techniques such as greater-occipital-nerve block (GONB) can help relieve the pain and reduce the frequency of headaches. Our study assessed the efficacy of ultrasound-guided greater-occipital-nerve block (USgGONB) in chronic migraines (CM) and its relationship to serum CGRP levels. Methods: Forty chronic migraineurs who underwent bilateral USgGONB using 40 mg triamcinolone and 1 mL lidocaine were recruited and interictal serum CGRP samples were collected immediately before and one month after GONB. The clinical response was evaluated using headache diaries before and one month after USgGONB. The patient response was determined after USgGONB according to the reduction in headache days as a good responder (>50% reduction), poor responder (<50%) or non-responder. Results: Monthly headache days after GONB showed a significant reduction (median, 10 days; range, 8–14.7) compared to before the block (median, 18 days; range, 17–22; p < 0.001). Across all patients, interictal serum CGRP levels after USgGONB were significantly lower than before the block (median, 40 pg/mL (range, 25–60) vs. 145 pg/mL (range, 60–380) (p = 0.001). The pre-treatment interictal CGRP levels showed a significant difference (p = 0.003), as their levels in non-responders (median, 310 pg/mL; interquartile range, 262–350) were significantly higher than those seen in responders, whether poor responders (median, 135 pg/mL; interquartile range, 100–200 pg/mL) or good responders (median, 140 pg/mL; interquartile range, 80–150 pg/mL). Conclusion: the study showed the beneficial effect of USgGONB in chronic migraines that was associated with lowering interictal CGRP levels, implying a potential role for CGRP in the mechanism of action of GONB in CM, and the interictal CGRP level may be used as a predictor for the response to GONB. MDPI 2022-02-07 /pmc/articles/PMC8883968/ /pubmed/35225886 http://dx.doi.org/10.3390/neurolint14010016 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Abbas, Abdelrahman
Moustafa, Ramez
Shalash, Ali
Haroun, Mahmoud
Amin, Randa
Borham, Sherien
Elsadek, Ahmed
Helmy, Shahinaz
Serum CGRP Changes following Ultrasound-Guided Bilateral Greater-Occipital-Nerve Block
title Serum CGRP Changes following Ultrasound-Guided Bilateral Greater-Occipital-Nerve Block
title_full Serum CGRP Changes following Ultrasound-Guided Bilateral Greater-Occipital-Nerve Block
title_fullStr Serum CGRP Changes following Ultrasound-Guided Bilateral Greater-Occipital-Nerve Block
title_full_unstemmed Serum CGRP Changes following Ultrasound-Guided Bilateral Greater-Occipital-Nerve Block
title_short Serum CGRP Changes following Ultrasound-Guided Bilateral Greater-Occipital-Nerve Block
title_sort serum cgrp changes following ultrasound-guided bilateral greater-occipital-nerve block
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8883968/
https://www.ncbi.nlm.nih.gov/pubmed/35225886
http://dx.doi.org/10.3390/neurolint14010016
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