Soluble CD40 ligand and prolactin levels in migraine patients during interictal period

Considerations for hormonal therapy in migraine patients: a critical review of current practice

INTRODUCTION

Migraine, a neurovascular headache disorder, is a leading cause of disability worldwide. Within the multifaceted pathophysiology of migraine, hormonal fluctuations play an evident triggering and exacerbating role, pointing toward the need for identification and proper usage of both existing and new hormonal targets in migraine treatment.

AREAS COVERED

With a threefold higher incidence of migraine in women than in men, the authors delve into sex hormone-related events in migraine patients. A comprehensive overview is given of existing hormonal therapies, including oral contraceptives, intrauterine devices, transdermal and subcutaneous estradiol patches, gnRH-agonists, oral testosterone, and 5α reductase inhibitors. The authors discuss their effectiveness and risks, noting their suitability for different patient profiles. Next, novel evolving hormonal treatments, such as oxytocin and prolactin, are explored. Lastly, the authors cover hormonal conditions associated with migraine, such as polycystic ovary syndrome, endometriosis, and transgender persons receiving gender affirming hormone therapy, aiming to provide more personalized and effective solutions for migraine management.

EXPERT OPINION

Rigorous research into both existing and new hormonal targets, as well as the underlying pathophysiology, is needed to support a tailored approach in migraine treatment, in an ongoing effort to alleviate the impact of migraine on individuals and society.

Increased serum prolactin level may indicate more migraine attack frequency

OBJECTIVES

Migraine is a common, multifactorial disorder. The exact pathomechanism of migraine remains unclear. Studies have revealed changes in serum prolactin (PRL) levels in relation to migraine, although the results have been inconsistent. The present case-control study assessed the serum level of prolactin in migraine patients.

MATERIALS AND METHODS

In this case-control study, participants were divided into chronic migraine (CM; n = 39), episodic migraine in ictal (during an attack), and interictal (between attacks) phases (n = 63, n = 37, respectively) along with 30 age- and sex-matched headache-free controls. After obtaining demographic, anthropometric data, and headache characteristics, blood samples were gathered and analyzed to evaluate the serum levels of prolactin (ng/mL).

RESULTS

A significant difference was observed between the control, CM, and ictal EM, and interictal EM groups. The mean ± SD serum prolactin levels of the chronic migraineurs (1.82 ± 0.94) and those with ictal EM (1.93 ± 1.70) were comparable and were significantly higher than for interictal EM patients (0.82 ± 0.46) and the headache-free control subjects (0.49 ± 0.15; p < .001). Although the mean serum concentration of prolactin for the interictal EM group tended to be higher than for control individuals, this difference was not statistically significant. The Spearman's correlation test also showed significant correlations between the serum prolactin levels and the number of headaches days among migraineurs.

CONCLUSION

The findings suggest that there might be an association between increased prolactin concentrations and migraine headache induction and progression. Further detailed and well-designed studies are needed to confirm the importance of serum prolactin levels in the pathogenesis of migraine headaches.

Prolactin in headache and migraine: A systematic review of clinical studies

OBJECTIVE

To systemically review clinical studies investigating the role of prolactin and its receptors in headache and migraine.

BACKGROUND

Migraine prevalence is more common in women compared to men. As prolactin is a crucial regulator of the hypothalamus-pituitary-gonadal axis, prolactin and its receptors might contribute to signaling mechanisms underlying migraine.

METHODS

In this systematic review, we searched PubMed and EMBASE with the terms: prolactin, hyperprolactinemia, macroprolactinemia, hypoprolactinemia, migraine, headache, head pain and trigeminal pain pathway for clinical studies investigating prolactin signaling in headache and migraine. Two reviewers independently screened 841 articles for population, intervention, comparison, outcome, and study design. Studies were restricted to the English language and were excluded if they had a nonexperimental methodology.

RESULTS

Nineteen clinical studies met the inclusion criteria and were included in the qualitative and quantitative analysis. The main findings were that serum prolactin levels were found to be higher in individuals with migraine compared to healthy controls, and prolactinomas (prolactin-secreting pituitary adenomas) were correlated with higher incidence of headache in otherwise healthy individuals and migraine attacks in individuals with migraine.

CONCLUSION

Considerable evidence suggests a key role of prolactin and its receptors in migraine pathophysiology. Further randomized and placebo-controlled clinical studies targeting prolactin signaling are needed to further clarify influences of prolactin in migraine attack initiation.

Selected Factors of Vascular Changes: The Potential Pathological Processes Underlying Primary Headaches in Children

Background: The prevalence, social consequences and complicated pathogenesis make headaches in children a significant clinical issue. Studies in adults suggest that primary headaches could be the first sign of atherosclerosis and platelet aggregation. Aim: To analyze the blood levels of selected biomarkers of vascular changes potentially associated with a higher risk of atherosclerosis in children with primary headaches. Methods: The medical family history, brain-derived neurotrophic factor (BDNF), soluble CD40 ligands (sCD40L), endothelial plasminogen activator inhibitor (PAI I), vascular endothelial growth factor (VEGF) and intima-media thickness (IMT) measurements were performed in the 83 children (52 with primary headaches, 31 controls). Selected factors were compared with basic laboratory parameters that are potentially related to atherosclerosis: C-reactive protein (CRP) and lipid concentration. Results: There were no significant differences in biomarkers of vascular changes in the study group and controls in general. In the study group, boys had a higher BDNF level than girls (p = 0.046). Normal-weight migraine patients had significantly higher PAI-I levels than controls (p = 0.034). A positive correlation between PAI-1 and triglycerides (TG) was observed. IMT did not differ between children with primary headaches and controls; however, IMT showed a positive correlation with BMI z-score and TG. Children with headaches had, more often, a positive family history of cardiovascular disease (p = 0.049). Conclusions: There were no clear clinical changes indicative of atherosclerosis in the study population. However, some trends are visible. Primary headaches are more often related to a family history of cardiovascular diseases. IMT is associated with TG levels and BMI z-score. The measured biomarkers of vascular changes show mutual relations.

No change in interictal C-reactive protein levels in individuals with episodic and chronic migraine: A case-control study and literature review

Objectives

The levels of some migraine biomarkers differ between episodic migraine (EM) and chronic migraine (CM), but information on C-reactive protein (CRP) levels in EM and CM is conflicting. Thus, this study aimed to evaluate CRP levels in participants with EM and CM in comparison to those in healthy controls.

Methods

Plasma CRP levels were evaluated by high-sensitivity CRP tests in female participants with EM (n = 174) and CM (n = 191) and healthy controls (n = 50).

Results

The results showed no significant difference in CRP levels among the EM, CM, and control groups (median and interquartile range, 0.40 [0.15-0.70] mg/L vs. 0.40 [0.15-1.00] mg/L vs. 0.15 [0.15-0.90] mg/L, p = 0.991). The ratio of individuals with elevated CRP levels (>3.0 mg/L) did not significantly differ among the EM, CM, and control groups (3.4% [6/174] vs. 2.1% [4/191] vs. 0.0% [0/50], p = 0.876). Multivariable regression analyses revealed that CRP levels were not significantly associated with headache frequency per month (β = -0.076, p = 0.238), the severity of anxiety (Generalized Anxiety Disorder-7 score, β = 0.143, p = 0.886), and depression (Patient Health Questionnaire-9 score, β = 0.143, p = 0.886). Further, CRP levels did not significantly differ according to clinical characteristics, fibromyalgia, medication overuse, preventive treatment, and classes of preventive treatment medications. Among participants with a body mass index ≥25 kg/m², the CRP levels in EM (n = 41) and CM (n = 17) were numerically higher than those in the control (n = 6) (1.30 [0.28-4.25] mg/L vs. 1.10 [0.50-3.15] mg/L vs. 0.40 [0.15-0.83] mg/L, p = 0.249) but did not reach statistical significance.

Conclusions

The interictal CRP level is not likely to be a biomarker for EM or CM.

Prolactin signaling modulates stress-induced behavioral responses in a preclinical mouse model of migraine

OBJECTIVE

The aim of this study was to determine if prolactin signaling modulates stress-induced behavioral responses in a preclinical migraine model.

BACKGROUND

Migraine is one of the most complex and prevalent disorders. The involvement of sex-selective hormones in migraine pathology is highly likely as migraine is more common in women and its frequency correlates with reproductive stages. Prolactin has been shown to be a worsening factor for migraine. Normally prolactin levels are low; however levels can surge during stress. Dopamine receptor agonists, which suppress pituitary prolactin release, are an effective migraine treatment in a subset of patients. Previously, we showed that administration of prolactin onto the dura mater induces female-specific behavioral responses, suggesting that prolactin may play a sex-specific role in migraine.

METHODS

The effects of prolactin signaling were assessed using a preclinical migraine model we published recently in which behavioral sensitization is induced by repeated stress. Plasma prolactin levels were assessed in naïve and stressed CD-1 mice (n = 3-5/group) and transgenic mice with conditional deletion of the Prlr in Nav1.8-positive sensory neurons (Prlr conditional knock-out [CKO]; n = 3/group). To assess the contribution of prolactin release during stress, naïve or stressed male and female CD-1 mice were treated with the prolactin release inhibitor bromocriptine (2 mg/kg; n = 7-12/group) or vehicle for 5 days (8-12/group) and tested for facial hypersensitivity following stress. Additionally, the contribution of ovarian hormones in regulating the prolactin-induced responses was assessed in ovariectomized female CD-1 mice (n = 6-10/group). Furthermore, the contribution of Prlr activation on Nav1.8-positive sensory neurons was assessed. Naïve or stressed male and female Prlr CKO mice and their control littermates were tested for facial hypersensitivity (n = 8-9/group). Immunohistochemistry was used to confirm loss of Prlr in Nav1.8-positive neurons in Prlr CKO mice. The total sample size is n = 245; the full analysis sample size is n = 221.

RESULTS

Stress significantly increased prolactin levels in vehicle-treated female mice (39.70 ± 2.77; p < 0.0001). Bromocriptine significantly reduced serum prolactin levels in stressed female mice compared to vehicle-treated mice (-44.85 ± 3.1; p < 0.0001). Additionally, no difference was detected between female stressed mice that received bromocriptine compared to naïve mice treated with bromocriptine (-0.70 ± 2.9; p = 0.995). Stress also significantly increased serum prolactin levels in male mice, although to a much smaller extent than in females (0.61 ± 0.08; p < 0.001). Bromocriptine significantly reduced serum prolactin levels in stressed males compared to those treated with vehicle (-0.49 ± 0.08; p = 0.002). Furthermore, bromocriptine attenuated stress-induced behavioral responses in female mice compared to those treated with vehicle (maximum effect observed on day 4 post stress [0.21 ± 0.08; p = 0.03]). Bromocriptine did not attenuate stress-induced behavior in males at any timepoint compared to those treated with vehicle. Moreover, loss of ovarian hormones did not affect the ability of bromocriptine to attenuate stress responses compared to vehicle-treated ovariectomy mice that were stressed (maximum effect observed on day 4 post stress [0.29 ± 0.078; p = 0.013]). Similar to CD-1 mice, stress increased serum prolactin levels in both Prlr CKO female mice (27.74 ± 9.96; p = 0.047) and control littermates (28.68 ± 9.9; p = 0.041) compared to their naïve counterparts. There was no significant increase in serum prolactin levels detected in male Prlr CKO mice or control littermates. Finally, conditional deletion of Prlr from Nav1.8-positive sensory neurons led to a female-specific attenuation of stress-induced behavioral responses (maximum effect observed on day 7 post stress [0.32 ± 0.08; p = 0.007]) compared to control littermates.

CONCLUSION

These data demonstrate that prolactin plays a female-specific role in stress-induced behavioral responses in this preclinical migraine model through activation of Prlr on sensory neurons. They also support a role for prolactin in migraine mechanisms in females and suggest that modulation of prolactin signaling may be an effective therapeutic strategy in some cases.

Metabolic profile changes in serum of migraine patients detected using 1H-NMR spectroscopy

Background

Migraine is a common brain disorder but reliable diagnostic biomarkers in blood are still lacking. Our aim was to identify, using proton nuclear magnetic resonance (¹H-NMR) spectroscopy, metabolites in serum that are associated with lifetime and active migraine by comparing metabolic profiles of patients and controls.

Methods

Fasting serum samples from 313 migraine patients and 1512 controls from the Erasmus Rucphen Family (ERF) study were available for ¹H-NMR spectroscopy. Data was analysed using elastic net regression analysis.

Results

A total of 100 signals representing 49 different metabolites were detected in 289 cases (of which 150 active migraine patients) and 1360 controls. We were able to identify profiles consisting of 6 metabolites predictive for lifetime migraine status and 22 metabolites predictive for active migraine status. We estimated with subsequent regression models that after correction for age, sex, BMI and smoking, the association with the metabolite profile in active migraine remained. Several of the metabolites in this profile are involved in lipid, glucose and amino acid metabolism.

Conclusion

This study indicates that metabolic profiles, based on serum concentrations of several metabolites, including lipids, amino acids and metabolites of glucose metabolism, can distinguish active migraine patients from controls.

Supplementary Information

The online version contains supplementary material available at 10.1186/s10194-021-01357-w.

A link between migraine and prolactin: the way forward

Migraine is an incapacitating neurological disorder that predominantly affects women. Sex and other hormones (e.g., oxytocin, and prolactin) may play a role in sexual dimorphic features of migraine. Initially, prolactin was recognized for its modulatory action in milk production and secretion; later, its roles in the regulation of the endocrine, immune and nervous systems were discovered. Higher prolactin levels in individuals with migraine were found in earlier studies, with a female sex-dominant trend. Studies that are more recent have identified that the expression of prolactin receptor in response to neuronal excitability and stress depends on sex with a dominant role in females. These findings have opened up potentials for explanation of sex-related pathophysiology of migraine, but have left some unanswered questions. This focused review examines the past and present of the link between prolactin and migraine, and presents open questions and directions for future experimental and clinical efforts.

Sex hormones (e.g., estrogen and progesterone) have been investigated to explain the sex-related manifestation of migraine, which is predominant in females. Prolactin is known for promoting lactation, but accumulating evidence supports that it can promote pain in females. An increasing number of studies have shown that the expression of a prolactin receptor in female nociceptors and their responses to external stimuli such as stress are different, which can help explain the female sex-dominant feature of migraine. In this focused review, the current knowledge is presented and the directions where prolactin research in migraine may evolve are proposed. The ultimate goal is to shape an overview toward considering sex-based treatments for migraine with highlighting the role of prolactin.

Meningeal CGRP-Prolactin Interaction Evokes Female-Specific Migraine Behavior

OBJECTIVE

Migraine is three times more common in women. CGRP plays a critical role in migraine pathology and causes female-specific behavioral responses upon meningeal application. These effects are likely mediated through interactions of CGRP with signaling systems specific to females. Prolactin (PRL) levels have been correlated with migraine attacks. Here, we explore a potential interaction between CGRP and PRL in the meninges.

METHODS

Prolactin, CGRP, and receptor antagonists CGRP8-37 or Δ1-9-G129R-hPRL were administered onto the dura of rodents followed by behavioral testing. Immunohistochemistry was used to examine PRL, CGRP and Prolactin receptor (Prlr) expression within the dura. Electrophysiology on cultured and back-labeled trigeminal ganglia (TG) neurons was used to assess PRL-induced excitability. Finally, the effects of PRL on evoked CGRP release from ex vivo dura were measured.

RESULTS

We found that dural PRL produced sustained and long-lasting migraine-like behavior in cycling and ovariectomized female, but not male rodents. Prlr was expressed on dural afferent nerves in females with little-to-no presence in males. Consistent with this, PRL increased excitability only in female TG neurons innervating the dura and selectively sensitized CGRP release from female ex vivo dura. We demonstrate crosstalk between PRL and CGRP systems as CGRP8-37 decreases migraine-like responses to dural PRL. Reciprocally, Δ1-9-G129R-hPRL attenuates dural CGRP-induced migraine behaviors. Similarly, Prlr deletion from sensory neurons significantly reduced migraine-like responses to dural CGRP.

INTERPRETATION

This CGRP-PRL interaction in the meninges is a mechanism by which these peptides could produce female-selective responses and increase the prevalence of migraine in women. ANN NEUROL 2021;89:1129-1144.

Assessing the Effect of Zinc Supplementation on the Frequency of Migraine Attack, Duration, Severity, Lipid Profile and hs-CRP in Adult Women

Migraine is a widespread incapacitating neurologic disorder with debilitating headaches which are usually throbbing due to inefficacy and several side effects, complementary therapies recommended as possible alternatives. The current randomized controlled trial was carried out to evaluate the effect of zinc gluconate supplementation on migraine-related symptoms, serum level of high sensitivity C-reactive protein (hs-CRP) and lipid profile in migraineurs. Present study was designed as randomized double-blind, placebo-controlled trial. Sixty women with migraine (mean age of 35.44 ± 7.42 years) were randomly allocated to obtain 15 mg per day of zinc gluconate or placebo for 12 weeks. Frequency, periods of headaches and severity of migraine based on numerical rating scale questionnaire and migraine disability assessment (MIDAS) test were checked. Fasting serum level of lipid profile and hs-CRP were assessed at the beginning and the end of trial. Zinc gluconate supplementation significantly reduced the frequency (p = 0.001), periods of migraine attacks (p < 0.001) and severity of migraine and MIDAS (p < 0.001) compared with control group. The serum level of low-density lipoprotein (p < 0.001), total cholesterol (p < 0.001) and hs-CRP (p < 0.001) decreased following zinc supplementation, but no significant differences in serum level of triglycerides (p = 0.1) and high-density lipoprotein (p = 0.3) was observed. However, after adjustment for baseline values using analysis of covariance test, none of lipid profile components and hs-CRP showed a significant difference. Zinc supplementation has beneficial effect on the migraine related complications like its severity, frequency.

TRIAL REGISTRATION

Iranian Registry of Clinical Trials Identifier: IRCT20191014045100N1.

Headache in Children: Selected Factors of Vascular Changes Involved in Underlying Processes of Idiopathic Headaches

Headaches are common complaints in children. The International Classification of Headache Disorders, 3^rd edition (beta version), defines more than 280 types of headaches. Primary headaches refer to independent conditions that cause pain and include migraine, tension-type headaches (TTH), and trigeminal autonomic cephalalgias (TACs). Several agents are involved in the pathogenesis of headaches. The factors associated with predisposition to atherosclerosis seem to be particularly important from the clinical point of view. The influence of obesity on the incidence of headaches has been well established. Moreover, idiopathic headaches, especially migraine, are thought to be one of the first signs of disorders in lipid metabolism and atherosclerosis. The risk of migraine increases with increasing obesity in children. Another factor that seems to be involved in both obesity and headaches is the adiponectin level. Recent data also suggest new potential risk factors for atherosclerosis and platelet aggregation such as brain-derived neurotrophic factor (BDNF), sCD40L (soluble CD40 ligand), serpin E1/PAI I (endothelial plasminogen activator inhibitor), and vascular endothelial growth factor (VEGF). However, their role is controversial because the results of clinical studies are often inconsistent. This review presents the current knowledge on the potential markers of atherosclerosis and platelet aggregation, which may be associated with primary headaches.

Circulating Biomarkers in Migraine: New Opportunities for Precision Medicine

Background:

Migraine is the most common neurological disorder and the second most disabling human condition, whose pathogenesis is favored by a combination of genetic, epigenetic, and environmental factors. In recent years, several efforts have been made to identify reliable biomarker(s) useful to monitor disease activity and/or ascertain the response to a specific treatment.

Objective:

To review the current evidence on the potential biological markers associated with migraine.

Methods:

A structured search of peer-reviewed research literature was performed by searching major publications databases up to December 2017.

Results:

Several circulating biomarkers have been proposed as diagnostic or therapeutic tools in migraine, mostly related to migraine’s inflammatory pathophysiological aspects. Nonetheless, their detection is still a challenge for the scientific community, reflecting, at least in part, disease complexity and clinical diagnostic limitations. At the present time, calcitonin generelated peptide (CGRP) represents probably the most promising candidate as a diagnostic and/or therapeutic biomarker, as its plasma levels are elevated during migraine attack and decrease during successful treatment. Other molecules (including some neuropeptides, cytokines, adipokines, or vascular activation markers) despite promising, do not possess the sufficient prerequisites to be considered as migraine biomarkers.

Conclusion:

The characterization of migraine-specific biomarkers would be fundamental in a perspective of precision medicine, enabling risk assessment and tailored treatments. However, speculating on the clinical validity of migraine biomarkers may be premature and controlled clinical trials are presently needed to investigate both the diagnostic and therapeutic value of these biomarkers in migraine.

The impact of C-reactive protein levels on headache frequency in the HUNT study 2006-2008

BACKGROUND

Increased high sensitivity C- reactive protein (hs-CRP) levels have been found in many earlier studies on migraine, and recently also in persons with migraine and insomnia. The aim of this study was to see whether these findings could be reproduced in a large-scale population-based study.

METHODS

A total of 50,807 (54%) out of 94,194 invited aged ≥20 years or older participated in the third wave of the Nord-Trøndelag Health Study study performed in 2006-2008. Among these, 38,807 (41%) had valid measures of hs-CRP and answered questions on headache and insomnia. Elevated hs-CRP was defined as > 3.0 mg/L. The cross-sectional association with headache was estimated by multivariate analyses using multiple logistic regression. The precision of the odds ratio (OR) was assessed with 95% confidence interval (CI).

RESULTS

In the fully adjusted model, elevated hs-CRP was associated with migraine (OR 1.14, 95% CI 1.04-1.25) and migraine with aura (OR 1.15, 95% CI 1.03-1.29). The association was strongest among individuals with headache ≥15 days/month for any headache (OR 1.26, 95% CI 1.08-1.48), migraine (OR 1.62, 95% CI 1.21-2.17), and migraine with aura (OR 1.84, 95% CI 1.27-2.67). No clear relationship was found between elevated hs-CRP and headache less than 7 days/month or with insomnia.

CONCLUSIONS

Cross-sectional data from this large-scale population-based study showed that elevated hs-CRP was associated with headache ≥7 days/month, especially evident for migraine with aura.

Evidence for hyperprolactinemia in migraineurs: a systematic review and meta-analysis

BACKGROUND

One of the hypothalamus-pituitary axis hormones which may play a crucial role in pathophysiology of migraine is prolactin which is secreted from anterior pituitary gland and synthesized by various immune system cells as well. Whether prolactin blood levels can affect the migraine pathogenesis is an open question. Therefore, investigating prolactin circulatory levels in migraineurs may pave the way to underpin the mechanisms of migraine pathophysiology at biochemical levels. In the current investigation, the prolactin blood levels in the migraine subjects were investigated using systematic review and meta-analysis.

METHODS

Using online and specialized biomedical databases including Google Scholar, Medline, Pubmed, Pubmed Central, Embase, and Scopus, without the beginning date restriction until Feb 2019, the systematic review retrieved 11 publications in this systematic review after fulfilling for the inclusion and exclusion criteria. For heterogeneity, extent calculation statistical testing was applied. In the present study, the levels of circulatory prolactin in migraineurs assessed using standardized mean difference (SMD) as the effect size.

RESULTS

Q quantity and I²% statistic index showed a high heterogeneity in the 13 selected publications (188.370 and 92.568, respectively) and random-effects model was chosen for further analyses. The meta-analysis on a total number of 460 migraineurs and 429 healthy controls found that the weighted pooled SMD for the effects of prolactin blood concentrations on migraine pathogenesis was as follows: SMD = 1.435 (95% confidence interval, 0.854-2.015).

CONCLUSION

The current investigation presents evidence that prolactin blood levels are higher in migraineurs than healthy subjects.

Severe periodontitis is linked with increased peripheral levels of sTWEAK and PTX3 in chronic migraineurs

OBJECTIVES

Periodontitis (PD) and chronic migraine (CM) have been recently linked, and inflammatory processes and vascular endothelial changes are hypothesized as potential mediators of this relationship. The aim of this cross-sectional analysis was to investigate the potential association of PD with vascular systemic inflammation and complement activation in patients with CM.

MATERIALS AND METHODS

Ninety-four chronic migraineurs underwent a full-mouth periodontal evaluation and a measure of PD activity and severity, namely the periodontal inflamed surface area (PISA) was calculated for each patient. We divided CM patients according to their periodontal status: mild PD (N = 14), moderate PD (N = 22), severe PD (N = 19), and non-PD (N = 39). Serum levels of C-reactive protein (CRP), pentraxin 3 (PTX3), soluble tumor necrosis factor-like weak inducer of apoptosis (sTWEAK), and complements C3 and C4 were measured outside of migraine attacks.

RESULTS

We found that severe periodontal patients had significantly higher circulating levels of PTX3 and sTWEAK compared with those without PD (2475.3 ± 1646.8 pg/mL vs. 516.6 ± 1193.8 pg/mL, P < 0.0001 and 672.4 ± 118.2 pg/mL vs. 485.7 ± 112.2 pg/mL, P < 0.0001; respectively). For the remaining biomarkers, no significant differences were found between groups. Severe PD was independently associated with higher levels of PTX3 (β = 1997.6, P < 0.0001) and sTWEAK (β = 187.1, P < 0.0001) but not with CRP, C3, and C4. PISA positively correlated to PTX3 (r = 0.475, P < 0.0001) and sTWEAK (r = 0.386, P < 0.0001).

CONCLUSIONS

Based on these preliminary results, severe PD was linked with vascular systemic inflammation in patients with CM. However, further longitudinal studies should be performed to confirm these findings.

CLINICAL RELEVANCE

sTWEAK and PTX3 measured in serum could be used as biomarkers in the PD-CM link.

Does insomnia modify the association between C-reactive protein and migraine? The Tromsø Study 2015-2016

BACKGROUND

The relationship between high sensitivity C-reactive protein and migraine is unclear. The aim of this cross-sectional population-based study was to investigate the association between high sensitivity C-reactive protein and types of headache, and to evaluate the impact of insomnia on this association.

METHODS

A total of 20,486 (63%) out of 32,591 invited, aged ≥40 years or older, participated in the seventh wave of the Tromsø study conducted in 2015-2016 and had valid information on headache, insomnia and high sensitivity C-reactive protein. The influence of insomnia on the association between questionnaire-based diagnoses of headache and elevated high sensitivity C-reactive protein defined as >3.0 mg/L was assessed using multiple logistic regression, estimating prevalence odds ratio with 95% confidence intervals.

RESULTS

A total of 6290 participants (30.7%) suffered from headache during the last year. Among these, 1736 (8.5%) fulfilled the criteria of migraine, 991 (4.8%) had migraine with aura, 746 (3.6%) migraine without aura (3.8%), and 4554 (22.2%) had non-migrainous headache. In the final multi-adjusted analysis, elevated high sensitivity C-reactive protein was associated with headache (odds ratio 1.10, 95% confidence interval 1.01-1.20), migraine (odds ratio 1.17, 95% confidence interval 1.01-1.35), and migraine with aura (odds ratio 1.23, 95% confidence interval 1.01-1.53). No association was found between elevated high sensitivity C-reactive protein and migraine without aura or non-migrainous headache. The association between high sensitivity C-reactive protein and migraine was strongly dependent on insomnia status. Among individuals with insomnia, elevated high sensitivity C-reactive protein was associated with migraine (odds ratio 1.49, 95% confidence interval 1.02-2.17), and migraine with aura (odds ratio 1.59, 95% confidence interval 1.03-2.45), whereas no such relationship was found among those without insomnia.

CONCLUSIONS

In this cross-sectional study, participants with migraine, in particular migraine with aura, were more likely to have elevated high sensitivity C-reactive protein, evident only among those with insomnia.

Pituitary Hormones and Orofacial Pain

Clinical and basic research on regulation of pituitary hormones, extra-pituitary release of these hormones, distribution of their receptors and cell signaling pathways recruited upon receptor binding suggests that pituitary hormones can regulate mechanisms of nociceptive transmission in multiple orofacial pain conditions. Moreover, many pituitary hormones either regulate glands that produce gonadal hormones (GnH) or are regulated by GnH. This implies that pituitary hormones may be involved in sex-dependent mechanisms of orofacial pain and could help explain why certain orofacial pain conditions are more prevalent in women than men. Overall, regulation of nociception by pituitary hormones is a relatively new and emerging area of pain research. The aims of this review article are to: (1) present an overview of clinical conditions leading to orofacial pain that are associated with alterations of serum pituitary hormone levels; (2) discuss proposed mechanisms of how pituitary hormones could regulate nociceptive transmission; and (3) outline how pituitary hormones could regulate nociception in a sex-specific fashion. Pituitary hormones are routinely used for hormonal replacement therapy, while both receptor antagonists and agonists are used to manage certain pathological conditions related to hormonal imbalance. Administration of these hormones may also have a place in the treatment of pain, including orofacial pain. Hence, understanding the involvement of pituitary hormones in orofacial pain, especially sex-dependent aspects of such pain, is essential to both optimize current therapies as well as provide novel and sex-specific pharmacology for a diversity of associated conditions.

Redox Mechanisms in Migraine: Novel Therapeutics and Dietary Interventions

SIGNIFICANCE

Migraine represents the third most prevalent and the seventh most disabling human disorder. Approximately 30% of migraine patients experience transient, fully reversible, focal neurological symptoms (aura) preceding the attack. Recent Advances: Awareness of the hypothesis that migraine actually embodies a spectrum of illnesses-ranging from episodic to chronic forms-is progressively increasing and poses novel challenges for clarifying the underlying pathophysiological mechanisms of migraine as well as for the development of novel therapeutic interventions. Several theories have evolved to the current concept that a combination of genetic, epigenetic, and environmental factors may play a role in migraine pathogenesis, although their relative importance is still being debated.

CRITICAL ISSUES

One critical issue that deserves a particular attention is the role of oxidative stress in migraine. Indeed, potentially harmful oxidative events occur during the migraine attack and long-lasting or frequent migraine episodes may increase brain exposure to oxidative events that can lead to chronic transformation. Moreover, a wide variety of dietary, environmental, physiological, behavioral, and pharmacological migraine triggers may act through oxidative stress, with clear implications for migraine treatment and prophylaxis. Interestingly, almost all current prophylactic migraine agents exert antioxidant effects.

FUTURE DIRECTIONS

Increasing awareness of the role of oxidative stress and/or decreased antioxidant defenses in migraine pathogenesis and progression to a chronic condition lays the foundations for the design of novel prophylactic approaches, which, by reducing brain oxidative phenomena, could favorably modify the clinical course of migraine. Antioxid. Redox Signal. 28, 1144-1183.

Can we define migraine patients with blood high-sensitivity C-reactive protein and galectin-3 levels in the emergency department?

INTRODUCTION

Migraine, the most widespread cause of headache in young adults, is a frequent reason for presentation to emergency departments. The aim of this study was to determine the diagnostic value of serum galectin-3 and high-sensitivity C-reactive protein (hsCRP) levels in migraine patients.

MATERIAL AND METHODS

Serum galectin-3 and hsCRP levels were measured using enzyme-linked immunosorbent assay in 70 migraine patients and 70 healthy control subjects.

RESULTS

The mean values of hsCRP and galectin-3 levels were significantly higher in the migraine group than those in the control group (1.67 ±0.49, 1.12 ±0.38 mg/l, p < 0.001; and 3.76 ±1.45, 2.05 ±0.29 ng/ml, p < 0.001, respectively). When the diagnostic values of the biomarkers were assessed in the migraine attack and control groups, the sensitivity and specificity of the test for hsCRP at the cut-off point of 1.32 mg/l were 70% and 73% (AUC = 0.805, 95% CI: 0.74-0.88, p < 0.001), and for galectin-3 at the cut-off point of 2.4 ng/ml, 89% and 90% (AUC = 0.97, 95% CI: 0.95-0.99, p < 0.001), respectively.

CONCLUSIONS

This study showed the presence of a relation between high serum levels of hsCRP and galectin-3 in migraine patients. However, well-controlled, carefully executed longitudinal studies are required to confirm these findings.

The relationship between levels of plasma-soluble urokinase plasminogen activator receptor (suPAR) and presence of migraine attack and aura

Migraine is one of the most common types of pain associated with sterile inflammatory conditions. Soluble urokinase plasminogen activator receptor (suPAR) is a potential novel inflammatory marker. We aim to determine the association between serum values of suPAR, procalcitonin, fibrinogen, and high-sensitivity C-reactive protein (hs-CRP) and migraine disease characteristics. The study involved a total of 60 migraine patients (33 patients in the interictal period, 27 patients in the attack period) and 30 healthy individuals. The serum values of suPAR were found to be significantly higher in migraine patients in the attack period than in migraine patients in the interictal period, and in healthy individuals (p < .01 for both). In addition, levels of suPAR were determined to be higher in migraine with aura patients than in migraine without aura patients. When we subdivided migraine patients according to frequency of attack (attacks/month), significant differences were found between the suPAR and procalcitonin levels (measured during the attack period) of those in the frequent-attack group (4-5 or more) versus those in the less frequent attack group (less than 4). Serum levels of procalcitonin were shown to be significantly higher in migraine patients during the attack period compared with migraine patients in the interictal period and in control subjects (p = .001 for both). Significant differences were found between plasma levels of fibrinogen in migraine patients versus control subjects (p < .01). No statistically significant difference was found between levels of hs-CRP in migraine patients versus the control group. These findings may show that presenting a high level of suPAR in migraine patients with attack and aura results to predisposition to occurring on the symptoms and that high levels of suPAR, procalcitonin and fibrinogen in patients with migraine result in neurogenic inflammation during migraine headaches.

Copeptin for risk stratification in non-traumatic headache in the emergency setting: a prospective multicenter observational cohort study

BACKGROUND

In the emergency setting, non-traumatic headache is a benign symptom in 80% of cases, but serious underlying conditions need to be ruled out. Copeptin improves risk stratification in several acute diseases. Herein, we investigated the value of copeptin to discriminate between serious secondary headache and benign headache forms in the emergency setting.

METHODS

Patients presenting with acute non-traumatic headache were prospectively enrolled into an observational cohort study. Copeptin was measured upon presentation to the emergency department. Primary endpoint was serious secondary headache defined by a neurologic cause requiring immediate treatment of the underlying disease. Secondary endpoint was the combination of mortality and hospitalization within 3 months. Two board-certified neurologist blinded to copeptin levels verified the endpoints after a structured 3-month-telephone interview.

RESULTS

Of the 391 patients included, 75 (19%) had a serious secondary headache. Copeptin was associated with serious secondary headache (OR 2.03, 95%CI 1.52-2.70, p < 0.0001). Area under the curve (AUC) for copeptin to identify the primary endpoint was 0.70 (0.63-0.76). After adjusting for age > 50, focal-neurological abnormalities, and thunderclap onset of symptoms, copeptin remained an independent predictive factor for serious secondary headache (OR 1.74, 95%CI 1.26-2.39, p = 0.001). Moreover, copeptin improved the AUC of the multivariate logistic clinical model (p-LR-test < 0.001). Even though copeptin values were higher in patients reaching the secondary endpoint, this association was not significant in multivariate logistic regression.

CONCLUSIONS

Copeptin was independently associated with serious secondary headache as compared to benign headaches forms. Copeptin may be a promising novel blood biomarker that should be further validated to rule out serious secondary headache in the emergency department.

TRIAL REGISTRATION

Study Registration on 08/02/2010 as NCT01174901 at clinicaltrials.gov.

Sexual dysfunction in women with migraine and tension-type headaches

Primary headaches (PHAs) prominently affect the performance and life quality of people. Sexual dysfunction (SD) is an important health problem caused by several factors. This study aimed to compare the sexual function of women who have PHAs. Forty-one female patients who were diagnosed with migraine, 39 female patients who were diagnosed with tension-type headache (TTHA) and 41 healthy subjects were included in study. Sexual function of the cases were evaluated by using the 'Female Sexual Function Index (FSFI)'. Beck Depression Scale was applied to subjects and those who were diagnosed with depression were excluded from the study. SD was detected in both the migraine and TTHA groups. FSFI subgroup scores were statistically significantly lower in the migraine and TTHA groups compared with the control group. No significant differences were detected between the migraine and TTHA groups in terms of FSFI and its components. In addition, no significant differences were detected between the blood prolactin levels or SD and headache. It was concluded that primary headaches (which are chronic diseases) itself may cause SD in female patients with migraine and TTHA independently of factors that may cause development of SD such as comorbid condition, depression, drug use and age.

The relationship between dry eye and migraine

Presently, migraine and dry eye are both thought to have an inflammatory pathogenesis. We aimed to investigate dry eye findings and any relationship with headache characteristics in migraine patients with and without aura. In total, 58 migraineurs and 41 age- and gender-matched controls were enrolled in this prospective clinical study. The migraine diagnosis was made according to the International Classification of Headache Disorders II diagnostic criteria. All patients underwent a complete ophthalmologic examination including tear meniscus measurements, meibography, tear breakup time, Schirmer test and the Ocular Surface Disease Index questionnaire. The presence of dry eye was higher in migraineurs as compared to the control group, but this did not reach statistical significance (p = 0.282). Among the headache characteristics, the presence of aura was significantly higher, and disease and attack durations were significantly longer in migraineurs with dry eye than in those without dry eye (p = 0.009, p = 0.010, and p = 0.003, respectively). In multiple logistic regression model, attack duration was found to be independently associated with the presence of dry eye in migraine patients (OR; 95 % CI; p = 0.029). The results show that dry eye may present in migraine patients with greater presence of auras and longer disease and attack durations.

C-reactive protein and migraine. Facts or speculations?

Abstract Migraine is a highly prevalent and frequently disabling disorder. Since the pathogenesis of this condition has a strong inflammatory component and migraine is significantly associated with cardiovascular disease, we assess whether C-reactive protein (CRP) may be epidemiologically or casually linked with migraine. An electronic search on Medline, Scopus and Web of Science produced 17 studies reporting original data about the epidemiological association between CRP and migraine (1 retrospective, 1 interventional, 14 cross-sectional and 1 both interventional and cross-sectional). When all studies reporting sufficient data about CRP values were pooled (n=12; 6980 cases and 38,975 controls), the concentration of CRP was found to be significantly higher in patients with migraine than in controls (weighted mean difference 1.12 mg/L; 95% CI 1.01-1.25 mg/L; p<0.001). In further analysis of studies containing separate data for migraine with and without aura (n=7), CRP values remained significantly higher in both migraineur patients with aura (n=1939; weighted mean difference 0.88 mg/L; 95% CI 0.63-1.14 mg/L; p<0.001) or without aura (n=2483; weighted mean difference 1.04 mg/L; 95% CI 0.78-1.30 mg/L; p<0.001) when compared with controls (n=29,354). Despite a large inter-study heterogeneity (99.3%), our analysis provides evidence of a potential epidemiological association between increased concentration of CRP and migraine, thus paving the way for further clinical investigations about therapeutic agents that may contextually decrease the risk of cardiovascular disease and reduce the burden of migraine.

Tumor Necrosis Factor (TNF) -308G>A, Nitric Oxide Synthase 3 (NOS3) +894G>T Polymorphisms and Migraine Risk: A Meta-Analysis

Background and Objective

Conflicting data have been reported on the association between tumor necrosis factor (TNF) –308G>A and nitric oxide synthase 3 (NOS3) +894G>T polymorphisms and migraine. We performed a meta-analysis of case-control studies to evaluate whether the TNF –308G>A and NOS3 +894G>T polymorphisms confer genetic susceptibility to migraine.

Method

We performed an updated meta-analysis for TNF –308G>A and a meta-analysis for NOS3 +894G>T based on studies published up to July 2014. We calculated study specific odds ratios (OR) and 95% confidence intervals (95% CI) assuming allele contrast, dominant model, recessive model, and co-dominant model as pooled effect estimates.

Results

Eleven studies in 6682 migraineurs and 22591 controls for TNF –308G>A and six studies in 1055 migraineurs and 877 controls for NOS3 +894G>T were included in the analysis. Neither indicated overall associations between gene polymorphisms and migraine risk. Subgroup analyses suggested that the “A” allele of the TNF –308G>A variant increases the risk of migraine among non-Caucasians (dominant model: pooled OR = 1.82; 95% CI 1.15 – 2.87). The risk of migraine with aura (MA) was increased among both Caucasians and non-Caucasians. Subgroup analyses suggested that the “T” allele of the NOS3 +894G>T variant increases the risk of migraine among non-Caucasians (co-dominant model: pooled OR = 2.10; 95% CI 1.14 – 3.88).

Conclusions

Our findings appear to support the hypothesis that the TNF –308G>A polymorphism may act as a genetic susceptibility factor for migraine among non-Caucasians and that the NOS3 +894G>T polymorphism may modulate the risk of migraine among non-Caucasians.

Rapidly accomplished femtomole soluble CD40 ligand detection in human serum: a “green” homobifunctional agent coupled with reduced graphene oxide-tetraethylene pentamine as platform

A reliable and sensitive electrochemical immunosensor based on a “green” conjunction agent coupled with an amino-group qualified material was used for the analysis of soluble CD40 ligand.

Assessment of atrial electromechanical delay in patients with migraine

Evidence suggests that symptoms of migraine are related to the involvement of the autonomic nervous system. Data on atrial conduction system are limited in migraineurs. We aimed to assess atrial electromechanical delay using tissue Doppler imaging (TDI) in patients with migraine. Forty-five migraine patients and age- and sex-matched 26 control subjects were enrolled in the study. All the patients and controls underwent resting surface electrocardiogram (ECG) and TDI. The maximum P-wave duration (Pmax), minimum P-wave duration (Pmin) and P-wave dispersion (Pd) were measured from the 12-lead ECG. Atrial conduction time was determined from the lateral mitral annulus (PA lateral), septal mitral annulus (PA septal), and lateral tricuspid annulus (PA tricuspid) by TDI. Interatrial (PA lateral-PA tricuspid) and intraatrial (PA septal-PA tricuspid) electromechanical delays were calculated. Pd was significantly higher in migraine patients than in controls (p < 0.05), whereas Pmax and Pmin were not different between both groups (p > 0.05). PA lateral and PA septal durations were significantly higher in migraine patients than in controls (p < 0.001 and p < 0.05, respectively). However, PA tricuspid duration was similar between the groups (p > 0.05). Both interatrial and intraatrial conduction times were delayed in migraineurs as compared to the controls (p < 0.001). Interatrial delay and intraatrial delay variables were found as an independent risk factors separately on predicting atrial conduction abnormalities in migraineurs. An interatrial delay of 18 ms and an intraatrial delay of 5 ms were found to be cutoff values in ROC analysis (p < 0.001). This is the first report to provide a hypothetical suggestion that there is an atrial electromechanical delay in patients with migraine.

Vascular biomarkers in migraine

AIM

Migraine has been associated with stroke as well as with several non-atherosclerotic vascular conditions leading to discussions about the potential role of endothelium in the etiopathogenesis of migraine and migraine-associated stroke. We present a systematic review of the literature on vascular biomarkers in migraine, including those suggesting endothelial activation and damage.

METHODS

We conducted a systematic literature search from 1990 to 2013 using multiple research databases with the keywords "migraine," "headache," "vascular," and "biomarkers." We used selected inclusion and exclusion criteria to create a final pool of studies for this review.

RESULTS

The literature search identified a total of 639 citations of which 129 were included in our review. The final pool of clinical- and population-based studies assessed the level of various biomarkers (e.g. inflammatory, prothrombotic, endothelial activation, endothelial repair) in migraineurs of varying ages, gender, and demographic characteristics. Although for each biomarker there is at least one study suggesting an association with migraine, in many cases the quality of evidence is poor and there are conflicting studies showing no relationship. The results were, therefore, in each case inconclusive.

CONCLUSION

This systematic review indicated that in migraine populations there are a number of positive vascular biomarker studies, including some involving novel biomarkers such as endothelial microparticles and endothelial precursor cells. These lend insight into possible pathophysiological mechanisms by which migraine may be associated with stroke. More high-quality studies are needed to establish whether a true association between promising vascular biomarkers and migraine exists.

Serum levels of vitamin D, vitamin D-binding protein and vitamin D receptor in migraine patients from central Anatolia region

OBJECTIVES

Inflammation is proposed to be involved in the pathogenesis of both vitamin D deficiency and migraine. However, the data examining the relation of vitamin D with migraine are limited. We aimed to investigate the serum levels of vitamin D, vitamin D-binding protein (VDBP) and vitamin D receptor (VDR) in combination, in migraine patients from central Anatolia region.

METHODS

Fifty-two newly diagnosed migraine patients and age- and sex-matched 49 control subjects were enrolled in this cross-sectional prospective study. Migraine diagnosis was settled according to the International Classification of Headache Disorders-II diagnostic criteria. Serum samples were analysed for the measurement of vitamin D, VDBP and VDR levels by using commercial enzyme-linked immuno sorbent assay kits.

RESULTS

Serum vitamin D and VDR levels were found to be significantly lower in migraine patients than in controls (p = 0.012 and p = 0.038, respectively); whereas serum VDBP levels were similar between the groups (p > 0.05). There was no correlation between serum vitamin D, VDBP and VDR levels and headache characteristics including aura, attack severity, frequency and duration, and disease duration (p > 0.05). In terms of headache characteristics, no significant difference between migraineurs with vitamin D values < 25 and ≥ 25 ng/ml was observed (p > 0.05).

CONCLUSIONS

The present findings may suggest that decreased serum vitamin D levels were associated with migraine.

The omics in migraine

The term omics consist of three main areas of molecular biology, such as genomics, proteomics and metabolomics. The omics synergism recognise migraine as an ideal study model, due to its multifactorial nature. In this review, the plainly research data featuring in this complex network are reported and analyzed, as single or multiple factor in pathophysiology of migraine. The future of migraine biomolecular research shall be focused on networking among these different and hierarchical disciplines. We have to look for its Ariadne’s tread, in order to see the whole painting of migraine molecular biology.