Journal
CEPHALALGIA
Volume 40, Issue 1, Pages 57-67Publisher
SAGE PUBLICATIONS LTD
DOI: 10.1177/0333102419864507
Keywords
Pituitary adenylate cyclase-activating polypeptide; vasoactive intestinal polypeptide; migraine; headache; flushing; cyclic adenosine monophosphate
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Funding
- Candys Foundation, Liechtenstein
- Lundbeck Foundation [R155-2014-171]
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Introduction Pituitary adenylate cyclase-activating polypeptide (PACAP) is found in two functional isoforms, namely PACAP38 and PACAP27. The migraine-inducing properties of PACAP38 are well studied. However, it is not known whether the lesser-known and under-studied protein isoform, PACAP27, can also induce migraine attacks. Here, we studied the effect of human PACAP27 infusion on induction of migraine in a provocation model. Methods In a crossover study, 20 migraine without aura patients were randomly assigned to receive human PACAP27 (10 picomol/kg/min) or saline (placebo) infusion over 20 min. We recorded the migraine and associated symptoms. Results All patients completed the study. PACAP27 provoked migraine-like attacks in 11 patients (55%) and two developed attacks after placebo (10%) (p = 0.022). The headache intensity and duration after PACAP27 was significantly greater compared to placebo (p = 0.003). Conclusion PACAP27 triggers migraine attacks without aura. These novel data strengthen the role of PACAP and its receptors in migraine pathogenesis.
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