Serum CGRP, VIP, and PACAP usefulness in migraine: a case-control study in chronic migraine patients in real clinical practice.

Calcitonin gene-related peptide (CGRP), vasoactive intestinal peptide (VIP) and pituitary adenylate cyclase activating polypetide-38 (PACAP-38) have relevant roles in migraine pathophysiology. Their serum levels have been proposed as biomarkers for migraine. Our aim was to assess their diagnostic value in real clinical practice in a cohort of chronic migraine (CM), episodic migraine (EM) and healthy controls (HC). We recruited subjects with CM, EM and HC at two medical centers. Blood samples were drawn under fasting conditions in the interictal period, immediately centrifuged and stored at - 80 ºC. Serum levels were determined by ELISA. Neuropeptide levels, the effect of preventatives, correlations with clinical and demographic variables, and their diagnostic value were studied among clinical categories. 296 age- and sex-matched subjects (101 CM, 98 EM and 97 HC) were included. All three neuropeptide serum levels were higher in CM [median and IQ for CGRP = 18.023 pg/ml (14.4-24.7); VIP = 121.732 pg/ml (48.72-186.72) and PACAP = 204.931 pg/ml (101.08-597.64)] vs EM [CGRP = 14.659 pg/ml (10.29-17.45); VIP = 75.603 pg/ml (28.722-107.10); and PACAP = 94.992 pg/ml (65.77-128.48)] and vs HC [CGRP = 13.988 pg/ml (10.095-17.87); VIP = 84.685 pg/ml (35.32-99.79), and PACAP = 103.142 pg/ml (59.42-123.97)]. Using multinomial modeling, only VIP (OR 1.011, 95% CI 1.003-1.018, p = 0.005) and PACAP (OR 1.003, 95% CI 1.001-1.005, p = 0.002) increased the risk for CM, but not for EM. CGRP did not predict CM or EM. This model could correctly classify only 62/101 (61.38%) of CM, 75/98 (76.53%) of EM, and 5/97 (4.12%) of HC [globally 147/296 (49.8%)]. Individually, PACAP performed the best for classifying clinical categories [global accuracy 150/296 (50.67%)]. In CM, neuropeptide levels were higher in those OnaBT-treated than in no-treated patients. Although interictal serum CGRP and VIP were higher in CM than both EM or HC, their utility to discriminate migraine categories was low. Contrary to other studies, PACAP serum levels were also higher in CM than in EM or HC and had more discriminative capability to distinguish CM from EM and HC. Further investigation is needed for determination technique standardization.

[Attitudes of spanish primary care doctors to migraine]. / Actitud de los médicos de atención primaria españoles ante la cefalea.

OBJECTIVES: To find the attitude of Spanish primary care (PC) doctors to migraine, their ability to solve the problem and the therapy guidelines used. DESIGN: Transversal, descriptive study by means of a questionnaire sent out by mail. SETTING: PC doctors in Spain. PARTICIPANTS: A total of 721 PC doctors from all the health services. MAIN MEASUREMENTS: Approach, specialist referral, therapy preferences, and interest in training were measured through the questionnaire. RESULTS: Of the 1185 doctors to whom the questionnaire was sent out, 721 replied (60.8%); 69.8% showed very great or great interest in migraines; 12.2% referred to a specialist the first episode of migraine without aura; and 42.3%, of migraine with aura. The 32.3% referred the first episode of daily chronic migraine; and 56%, when linked to analgesic abuse. Paracetamol is the preferred medication for 61.2% of doctors in treating light migraine; NSAIDs are for 63.9% in moderate migraine; and tryptans are for 88.1% in severe cases. In pressure migraine, NSAIDs are preferred by 38%. Over 75% stated great or very great interest in training. CONCLUSIONS: Interest in migraines is high. There is considerable room for improvement in the capacity to solve certain kinds of migraines, especially chronic daily migraines. Some therapeutic guidelines are questionable. This, alongside the interest of doctors in training, points to the appropriateness of conducting training on this question.

Actitud de los médicos de atención primaria españoles ante la cefalea / Attitudes of Spanish primary care doctors to migraine

Objetivo. Conocer la actitud de los médicos de atención primaria (AP) frente a las cefaleas, su capacidad resolutiva y las pautas terapéuticas utilizadas. Diseño. Estudio descriptivo transversal, por medio de un cuestionario enviado por correo. Emplazamiento. Médicos de AP de nuestro país. Participantes. Participaron 721 médicos de AP de todos los servicios de salud. Mediciones principales. Se obtuvieron mediante un cuestionario sobre la actitud, la derivación al especialista, las preferencias terapéuticas y el interés en formación. Resultados. De los 1.185 médicos a los que se les envió el cuestionario, respondieron 721 (60,8%). El 69,8% refería interés muy alto o alto respecto a las cefaleas. El 12,2% deriva el primer episodio de migraña sin aura y un 42,3%, la migraña con aura, un 32,3% en la cefalea crónica diaria y un 56% cuando se asocia con abuso de analgésicos. El paracetamol es el fármaco preferido por un 61,2% de los médicos en el tratamiento de la crisis de migraña leve, mientras que en la moderada son los antiinflamatorios no esteroideos (AINE), con un 63,9%, y en la severa, los triptanes, con un 88,1%. En la cefalea tensional, son los AINE, con un 38%. Más del 75% refiere un interés alto o muy alto por la formación. Conclusiones. El interés por las cefaleas es alto. Hay un importante margen de mejora en la capacidad resolutiva en algunos tipos de cefaleas, sobre todo en las cefaleas crónicas diarias. Algunas pautas terapéuticas son discutibles. Esto, junto con el interés demostrado en formación, apunta a la conveniencia de llevar a cabo actuaciones formativas en esta materia

Objectives. To find the attitude of Spanish primary care (PC) doctors to migraine, their ability to solve the problem and the therapy guidelines used. Design. Transversal, descriptive study by means of a questionnaire sent out by mail. Setting. PC doctors in Spain. Participants. A total of 721 PC doctors from all the health services. Main measurements. Approach, specialist referral, therapy preferences, and interest in training were measured through the questionnaire. Results. Of the 1185 doctors to whom the questionnaire was sent out, 721 replied (60.8%); 69.8% showed very great or great interest in migraines; 12.2% referred to a specialist the first episode of migraine without aura; and 42.3%, of migraine with aura. The 32.3% referred the first episode of daily chronic migraine; and 56%, when linked to analgesic abuse. Paracetamol is the preferred medication for 61.2% of doctors in treating light migraine; NSAIDs are for 63.9% in moderate migraine; and tryptans are for 88.1% in severe cases. In pressure migraine, NSAIDs are preferred by 38%. Over 75% stated great or very great interest in training. Conclusions. Interest in migraines is high. There is considerable room for improvement in the capacity to solve certain kinds of migraines, especially chronic daily migraines. Some therapeutic guidelines are questionable. This, alongside the interest of doctors in training, points to the appropriateness of conducting training on this question