Human Electrophysiological Model to Quantify the CGRP-related Axon Reflex of Trigeminal Afferents

  • End date
    Feb 22, 2024
  • participants needed
  • sponsor
    University Hospital Tuebingen
Updated on 22 March 2021


The proposed project aims at establishing Calcitonin gene-related peptide (CGRP)-Related Axon Reflex of Trigeminal Afferents as a neurophysiological biomarker for migraine.


The proposed project aims at establishing a neurophysiological biomarker for migraine. Migraine is one of the world's most disabling diseases and its prophylactic treatment is time and cost-consuming. Since each patient responds differently and unpredictably to preventive medication, physicians are forced to try prophylactic drugs one by one. Recently, a new group of therapeutic agents targeting the neuropeptide Calcitonin gene-related peptide (CGRP) has been launched for migraine treatment. CGRP is stored in trigeminal afferents and released to meningeal blood vessels during acute migraine attacks leading to a vasodilating response. In an experimental setting, the release of CGRP from afferent nerve fibers in the skin can be induced by transdermal electrical stimulation. The subsequently evoked skin erythema, called 'flare reaction', can be quantified by laser Doppler imaging techniques. Never before, research studies used this experimental model in either trigeminally innervated skin or migraine patients. I therefore propose to establish this model to 1) test the specificity of an evoked 'flare response' in the trigeminal territory for the pathophysiology of migraine, 2) investigate the effect of CGRP-targeting anti-migraine drugs on this outcome parameter and 3) evaluate the impact of this model to predict the treatment response to drugs interfering with the CGRP-pathway. This study is a highly innovative approach towards tailored migraine treatment.

Condition Migraine, Migraine (Pediatric), Migraine (Adult), Primary Stabbing Headache, Migraine and Cluster Headaches, Migraine (Adult), Migraine and Cluster Headaches, Migraine (Pediatric), migraines
Treatment High frequency stimulation (HFS), Low-frequency sinusoidal transcutaneous stimulation (sLFS)
Clinical Study IdentifierNCT04796766
SponsorUniversity Hospital Tuebingen
Last Modified on22 March 2021


Yes No Not Sure

Inclusion Criteria

Healthy volunteers (Study Arm 1 and 2)
age 18 years
good German language skills
no history of head trauma
no history of neurologic disease
no primary headache disorder (e.g. migraine, episodic or chronic tension type headache, cluster headache)
no regular drug intake (except for oral contraceptives)
Migraine patients need to match the following criteria (Study Arm 2 and 3)
age 18 years
good German language skills
fulfilling the diagnostic criteria for either episodic or chronic migraine with or without aura according to the international classification of headache disorders (ICHD) 3rd edition
history of migraine > 1 year
keeping a headache diary for a minimum of 3 months prior to the study

Exclusion Criteria

Healthy volunteers and migraine patients under the following conditions will
be excluded
Chronic pain syndromes (e.g. low back pain, osteoarthritis, painful neuropathy, rheumatoid arthritis)
Acute pain (e.g. pain due to acute skin injury, menstrual pain, acute toothache). In this case, a measurement can only be performed after complete remission of pain and at least 48 hours after intake of acute pain medication (e.g. triptans, non-steroidal anti-inflammatory drug (NSAID))
history of treatment with agents targeting the CGRP pathway (e.g. erenumab) < 3 months before the study
history of treatment with Botulinum toxin < 9 months before the study
Diseases of the skin involving the skin at face and forehead
Pregnancy or breast feeding
Subjects lacking capacity for consent
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