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Ultrasound assessment of cerebrovascular risk via breath-holding index in migraine patients treated with anti-CGRP monoclonal antibodies: a pilot study Cover

Ultrasound assessment of cerebrovascular risk via breath-holding index in migraine patients treated with anti-CGRP monoclonal antibodies: a pilot study

Open Access
|Jun 2026

References

  1. Burch RC, Buse DC, Lipton RB. Migraine: Epidemiology, Burden, and Comorbidity. Neurol Clin. 2019 Nov;37(4):631–649. doi: 10.1016/j.ncl.2019.06.001.
  2. Goadsby PJ, Sprenger T. Current practice and future directions in the prevention and acute management of migraine. Lancet Neurol. 2010 Mar;9(3):285–298. doi: 10.1016/S1474-4422(10)70005-3.
  3. Charles A. The pathophysiology of migraine: implications for clinical management. Lancet Neurol. 2018 Feb;17(2):174–182. doi: 10.1016/S1474-4422(17)30435-0.
  4. Messina R, Huessler EM, Puledda F, Haghdoost F, Lebedeva ER, Diener HC. Safety and tolerability of monoclonal antibodies targeting the CGRP pathway and gepants in migraine prevention: A systematic review and network meta-analysis. Cephalalgia. 2023 Mar;43(3):3331024231152169. doi: 10.1177/03331024231152169.
  5. Favoni V, Giani L, Al-Hassany L, Asioli GM, Butera C, de Boer I, et al. CGRP and migraine from a cardiovascular point of view: what do we expect from blocking CGRP? J Headache Pain. 2019 Mar 12;20(1):27. doi: 10.1186/s10194-019-0979-y.
  6. Grell AS, Haanes KA, Johansson SE, Edvinsson L, Sams A. Fremanezumab inhibits vasodilatory effects of CGRP and capsaicin in rat cerebral artery – potential role in conditions of severe vasoconstriction. Eur J Pharmacol. 2019 Dec 1;864:172726. doi: 10.1016/j.ejphar.2019.172726.
  7. Edvinsson L, Nilsson E, Jansen-Olesen I. Inhibitory effect of BIBN4096BS, CGRP(8-37), a CGRP antibody and an RNA-Spiegelmer on CGRP induced vasodilatation in the perfused and non-perfused rat middle cerebral artery. Br J Pharmacol. 2007 Mar;150(5):633–640. doi: 10.1038/sj.bjp.0707134.
  8. Eller MT, Schwarzová K, Gufler L, Karisik A, Kaltseis K, Frank F, Broessner G. CGRP-targeted migraine therapies in patients with vascular risk factors or stroke: a review. Neurology. 2025 Jul 22;105(2):e213852. doi: 10.1212/WNL.0000000000213852.
  9. Carter SC, Cucchiara B, Reehal N, Hamilton K, Kaiser EA, Favilla CG. Effect of CGRP inhibitors on interictal cerebral hemodynamics in individuals with migraine. Front Neurol. 2024 Apr 29;15:1399792. doi: 10.3389/fneur.2024.1399792.
  10. Claassen JAHR, Thijssen DHJ, Panerai RB, Faraci FM. Regulation of cerebral blood flow in humans: physiology and clinical implications of autoregulation. Physiol Rev. 2021 Oct 1;101(4):1487–1559. doi: 10.1152/physrev.00022.2020.
  11. Silvestrini M, Vernieri F, Pasqualetti P, Matteis M, Passarelli F, Troisi E, Caltagirone C. Impaired cerebral vasoreactivity and risk of stroke in patients with asymptomatic carotid artery stenosis. JAMA. 2000 Apr 26;283(16):2122–2127. doi: 10.1001/jama.283.16.2122.
  12. Sacco S, Amin FM, Ashina M, Bendtsen L, Deligianni CI, Gil-Gouveia R, et al. European Headache Federation guideline on the use of monoclonal antibodies targeting the calcitonin gene related peptide pathway for migraine prevention – 2022 update. J Headache Pain. 2022 Jun 11;23(1):67. doi: 10.1186/s10194-022-01431-x.
  13. Headache Classification Committee of the International Headache Society (IHS). The International Classification of Headache Disorders, 3rd edition. Cephalalgia. 2018 Jan;38(1):1–211. doi: 10.1177/0333102417738202.
  14. Dora B, Balkan S, Tercan E. Normalization of high interictal cerebrovascular reactivity in migraine without aura by treatment with flunarizine. Headache. 2003 May;43(5):464–469. doi: 10.1046/j.1526-4610.2003.03091.x.
  15. Altamura C, Viticchi G, Fallacara A, Costa CM, Brunelli N, Fiori C, et al. Erenumab does not alter cerebral hemodynamics and endothelial function in migraine without aura. Cephalalgia. 2021 Jan;41(1):90–98. doi: 10.1177/0333102420956692.
  16. Altamura C, Paolucci M, Brunelli N, Cascio Rizzo A, Cecchi G, Assenza F, et al. Right-to-left shunts and hormonal therapy influence cerebral vasomotor reactivity in patients with migraine with aura. PLoS One. 2019 Aug 1;14(8):e0220637. doi: 10.1371/journal.pone.0220637.
  17. European Medicines Agency. [Internet]. Available at: http://www.ema.europa.eu/ (Accessed: 23.10.2024).
  18. Staszewski J, Skrobowska E, Piusińska-Macoch R, Brodacki B, Stępień A. Cerebral and extracerebral vasoreactivity in patients with different clinical manifestations of cerebral small-vessel disease: data from the significance of hemodynamic and hemostatic factors in the course of different manifestations of cerebral small-vessel disease study. J Ultrasound Med. 2019 Apr;38(4):975–987. doi: 10.1002/jum.14782.
  19. Gunda ST, Ng TKV, Liu TY, Chen Z, Han X, Chen X, et al. A comparative study of transcranial color-coded Doppler (TCCD) and transcranial Doppler (TCD) ultrasonography techniques in assessing the intracranial cerebral arteries haemodynamics. Diagnostics (Basel). 2024 Feb 10;14(4):387. doi: 10.3390/diagnostics14040387.
  20. Widder B. Cerebral vasoreactivity. In: Hennerici M, Meairs S (eds.): Cerebrovascular ultrasound: theory, practice and future developments. Cambridge: Cambridge University Press; 2001. p. 324–334. doi: 10.1017/CBO9780511759079.024.
  21. Marcic M, Marcic L, Marcic B, Capkun V, Vukojevic K. Cerebral vasoreactivity evaluated by transcranial color Doppler and breath-holding test in patients after SARS-CoV-2 infection. J Pers Med. 2021 May 6;11(5):379. doi: 10.3390/jpm11050379.
  22. Urbanova BS, Schwabova JP, Magerova H, Jansky P, Markova H, Vyhnalek M, et al. Reduced cerebrovascular reserve capacity as a biomarker of microangiopathy in Alzheimer's disease and mild cognitive impairment. J Alzheimers Dis. 2018;63(2):465–477. doi: 10.3233/JAD-170815.
  23. Frederiksen SD, Haanes KA, Warfvinge K, Edvinsson L. Perivascular neurotransmitters: Regulation of cerebral blood flow and role in primary headaches. J Cereb Blood Flow Metab. 2019 Apr;39(4):610–632. doi: 10.1177/0271678X17747188.
  24. Iyengar S, Johnson KW, Ossipov MH, Aurora SK. CGRP and the trigeminal system in migraine. Headache. 2019 May;59(5):659–681. doi: 10.1111/head.13529.
  25. Russell FA, King R, Smillie SJ, Kodji X, Brain SD. Calcitonin gene-related peptide: physiology and pathophysiology. Physiol Rev. 2014 Oct;94(4):1099–1142. doi: 10.1152/physrev.00034.2013.
  26. Noseda R, Schain AJ, Melo-Carrillo A, Tien J, Stratton J, Mai F, et al. Fluorescently-labeled fremanezumab is distributed to sensory and autonomic ganglia and the dura but not to the brain of rats with uncompromised blood brain barrier. Cephalalgia. 2020 Mar;40(3):229–240. doi: 10.1177/0333102419896760.
  27. Jansen-Olesen I, Jørgensen L, Engel U, Edvinsson L. In-depth characterization of CGRP receptors in human intracranial arteries. Eur J Pharmacol. 2003 Nov 28;481(2–3):207–216. doi: 10.1016/j.ejphar.2003.09.021.
  28. Edvinsson L, Haanes KA, Warfvinge K, Krause DN. CGRP as the target of new migraine therapies – successful translation from bench to clinic. Nat Rev Neurol. 2018 Jun;14(6):338–350. doi: 10.1038/s41582-018-0003-1.
  29. Dzator JS, Howe PR, Wong RH. Profiling cerebrovascular function in migraine: A systematic review and meta-analysis. J Cereb Blood Flow Metab. 2021 May;41(5):919–944. doi: 10.1177/0271678X20964344.
  30. Markus HS, Harrison MJ. Estimation of cerebrovascular reactivity using transcranial Doppler, including the use of breath-holding as the vasodilatory stimulus. Stroke. 1992 May;23(5):668–673. doi: 10.1161/01.str.23.5.668.
DOI: https://doi.org/10.15557/jou.2026.0016 | Journal eISSN: 2451-070X | Journal ISSN: 2084-8404
Language: English
Submitted on: Oct 1, 2025
Accepted on: Feb 24, 2026
Published on: Jun 30, 2026
Published by: MEDICAL COMMUNICATIONS Sp. z o.o.
In partnership with: Paradigm Publishing Services
Publication frequency: 4 issues per year

© 2026 Gianvito Barbella, Pietro Antenucci, Vittorio Govoni, Ilaria Casetta, Maurizio Paciaroni, Marina Padroni, published by MEDICAL COMMUNICATIONS Sp. z o.o.
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 License.