Session 1 - Future of migraine management

Lars Edvinsson

MD, DMSci Professor, of Internal Medicine, Lund University, Lund, Sweden, and Copenhagen University, Denmark

CGRP appears to induce pain by modulating the activity of Aδ fibres at the nodes of Ranvier, where they occur in close proximity to C fibres. It is likely that CGRP induces cAMP and protein kinase A (PKA), resulting in inhibition/activation of K+ channels. This may offer a new therapeutic target for future migraine treatments.

References
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2. Haanes KA, Edvinsson L. Pathophysiological mechanisms in migraine and the identification of new therapeutic targets. CNS Drugs. 2019;33:525-537.
3. Zhang L, Kunkler PE, Knopp KL, et al. Role of intraganglionic transmission in the trigeminovascular pathway. Mol Pain. 2019;15:1744806919836570. doi: 10.1177/1744806919836570.
4. Melo-Carrillo A, Strassman AM, Nir RR, et al. Fremanezumab - A humanized monoclonal anti-CGRP antibody-inhibits thinly myelinated (Aδ) but not unmyelinated (C) meningeal nociceptors. J Neurosci. 2017;37:10587-10596.
5. Edvinsson JCA, Warfvinge K, Krause DN, et al. C-fibers may modulate adjacent Aδ-fibers through axon-axon CGRP signaling at nodes of Ranvier in the trigeminal system. J Headache Pain. 2019;20:105. doi: 10.1186/ s10194-019-1055-3.