Amylin and the amylin receptors in migraine: Is there another pathway to target?

Here, we review the available evidence implicating amylin in migraine, its relationship with calcitonin gene-related peptide (CGRP) and its potential utility as a therapeutic target. The pathophysiology of migraine is currently better understood and the role of CGRP is key. Treatments targeting this pathway have been successful and migraine is a complex disorder, with so many molecules being implicated. Amylin, as for CGRP, is part of the calcitonin/CGRP peptide family. Some therapies intended to block the CGRP pathway can also target amylin receptors. Similar to CGRP, amylin can trigger migraine attacks in a provocation study. Amylin plasma levels have been highlighted as a potential migraine biomarker in one study in migraine patients. Moreover, some preclinical studies in rodents have also discussed sex differences. Comprehending the distinct and overlapping mechanisms between amylin and CGRP signalling could develop further our understanding of migraine pathophysiology. In summary, this review reveals, through initial studies, that targeting the amylin pathway may have a potential role as a novel treatment option for those who may not respond to other treatments, or as a better alternative.