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Peer Carsten Tfelt-Hansen, PACAP-induced migraine: a possible CNS effect?, Brain, Volume 137, Issue 11, November 2014, Page e304, https://doi.org/10.1093/brain/awu166
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Sir, The two peptides pituitary adenyl cyclase-activating polypeptide-38 (PACAP) and vasoactive intestinal polypeptide (VIP), given intravenously in humans, both dilate extracerebral cranial arteries, but only PACAP38 (Schytz et al., 2009)—not vasoactive intestinal polypeptide (Rahmannn et al., 2008)—induces migraine-like attacks in patients with migraine. Possible mechanisms for the difference in migraine induction were investigated in a recent crossover study in which 16 of 24 patients with migraine developed migraine after intravenous PACAP infusion, and vasoactive intestinal polypeptide infusion induced migraine in 4 of 24 patients (Amin et al., 2014). Magnetic resonance angiography showed dilatation of the superficial temporal artery and the extracranial part of the middle meningeal artery after both polypeptides whereas there was no effect on the middle cerebral artery with neither polypeptide (Amin et al., 2014). The vasodilatation of the superficial temporal artery and middle meningeal artery was the same for both polypeptides after 20 min but only persisted after 2 h for PACAP38. The migraine-like attacks were treated effectively with subcutaneous sumatriptan (n = 6) and this was associated with a constriction of superficial temporal artery and middle meningeal artery but not middle cerebral artery (Amin et al., 2014).