Identifying the role of calcitonin gene-related peptide (CGRP) in autonomic dysfunction in migraine: A case control study
Abstract
Migraine is a common neurological disorder causing recurrent severe headaches, often accompanied by nausea, photophobia, and phonophobia. Its pathophysiology is multifactorial, with calcitonin gene-related peptide (CGRP) playing a major role. Beyond its vasodilatory and nociceptive actions, CGRP may contribute to autonomic dysfunction, which is frequently observed in migraine patients.
To evaluate the relationship between serum CGRP levels and autonomic dysfunction in migraine patients using validated clinical and laboratory assessments.
This case-control study was conducted at Ain Shams University Hospitals between March and September 2025. Forty-five patients with chronic migraines and matched healthy controls were included. Serum CGRP levels were measured, autonomic symptoms were assessed using the SCOPA-AUT questionnaire, and tilt table testing was performed to evaluate autonomic function.
Serum CGRP levels were significantly higher in migraine patients compared to controls (median 170 vs. 29.5, p ≤ 0.001). Patients reported more severe autonomic symptoms (median SCOPA-AUT score: 20 vs. 4, p ≤ 0.001). A strong positive correlation was observed between CGRP levels and autonomic dysfunction scores (r = 0.761, p < 0.001). Tilt table–positive patients also showed higher CGRP levels, supporting the link between CGRP dysregulation and autonomic instability.
CGRP is strongly associated with autonomic dysfunction in migraine patients, suggesting a neurogenic basis for…
How strong is the evidence?
Evidence Hub reads this as a case-control, done in people. Its evidence level is 4 of 5 (Low · observational). Observational designs can show an association but not prove cause.
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