Periodontitis Linked to Increased CGRP Levels in Chronic Migraine

In individuals with chronic migraine, periodontal inflammation is associated with increased circulating levels of calcitonin gene-related peptide (CGRP), according to a study published in the Journal of Periodontology.

CGRP is a key element in migraine pathophysiology, and this cohort study was designed to investigate the possibility of a link between periodontal inflammation and CGRP in individuals with chronic migraine. Included in the study were 102 participants with chronic migraine and 77 age- and sex-matched participants without headache or migraine. To quantify periodontal inflammation status for each participant, full-mouth periodontal parameters were recorded and periodontal inflamed surface area (PISA) was calculated. A standard questionnaire was used to assess comorbidities and sociodemographic data. Blood samples were collected and serum concentrations were measured for CGRP and interleukin (IL)-6 and -10.

Participants with chronic migraine compared with controls had significantly higher levels of serum IL-6 (12.8±8.6 vs 5.7±5.4 pg/mL, respectively; P <.0001) and CGRP (17.9±6.7 vs 6.8±4.2 pg/mL, respectively; P <.0001). Serum IL-10 levels were significantly lower in patients with chronic migraine than in controls (2.4±1.3 vs 4.7±3.4 pg/mL, respectively; P <.0001). Among participants with chronic migraine, those with periodontitis had higher levels of serum CGRP than those without periodontitis (19.7±6.5 vs 15.3±6.2 pg/mL, respectively; P <.0001), as well as higher levels of IL-6 (15.1±9.2 vs 9.6±6.3 pg/mL, respectively; P <.0001). Nonsignificant differences were observed with IL-10 concentrations (2.0±1.0 vs 2.8±1.5 pg/mL, respectively; P =.675). In participants with chronic migraine, PISA was independently associated with CGRP (β=.003; 95% CI, .001-.006; P =.031), and PISA correlated positively with CGRP (r=.236; P =.017) and IL-6 (r=.262; P =.008) in chronic migraine. Periodontitis was independently associated with increased serum CGRP levels in chronic migraine after adjusting for age, depression, gender, obesity, and low level of education (β=4.354; 95% CI, 1.685-7.024; P <.0001).

Researchers of the study concluded, “… periodontal inflammation is linked with higher serum levels of CGRP in patients with chronic migraine and this association could be mediated indeed by a systemic inflammatory state due to periodontitis.” They advise that this association warrants further investigation to confirm their findings and clarify the exact mechanisms underlying the relationship between periodontitis and CGRP in patients with chronic migraine.

Reference
Leira Y, Ameijeira P, Domínguez C, et al. Periodontal inflammation is related to increased serum calcitonin gene-related peptide (CGRP) levels in patients with chronic migraine [published online May 9, 2019]. J Periodontol. doi: 10.1002/JPER.19-0051