Objective:

To demonstrate effective use of calcitonin gene-related peptide (CGRP) modulating medications for post-traumatic brain injury (TBI) symptoms in a diverse group of patients and illuminate the potential utility of CGRP medications for regular use after TBI.

Background:

The mechanism by which CGRP results in headache and migraine spectrum symptoms has been established. CGRP is recently understood to remain elevated in rat models after concussion. These findings portend implications for application of CGRP modification in human patients with TBI. Persistent Postural-Perceptual Dizziness (3PD), is recently becoming better understood. Because of its close association with migraine headache, 3PD is also likely a derangement of CGRP and may benefit from medications for CGRP modulation.

Design/Methods:

Patient consent was obtained to share de-identified patient information and outcomes. Case management is ongoing and will be presented in depth and include relevant imaging, testing results, and graphical representation of symptom changes following treatment initiation (Figures 1-5).

Results:

Five patients are presented: Two patients surviving moderate TBI and three patients with prolonged symptoms after concussion were all identified as having chronic migraine by a neurologist and 3PD by a neuro-otologist (Table 1). These patients were treated with CGRP modifying medications with successful resolution of migraine and 3PD symptoms.

Conclusions:

Clinicians can use preliminary findings about CGRP secretion in animal and human models to predict symptom outcomes in at-risk patients and treat chronic concussion symptoms if they occur. We present five patients who now have reduced or eliminated chronic concussion symptoms after initiating medications that modulate CGRP and explain how these experiences can translate into our daily practices when caring for patients with TBI.