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Carlsen LN, Hansen CS, Kogelman LJA, Werge TM, Ullum H, Bybjerg-Grauholm J, Hansen TF, Jensen RH. DNA-methylation and immunological response in medication overuse headache. Cephalalgia 2023; 43:3331024221147482. [PMID: 36786322 DOI: 10.1177/03331024221147482] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
OBJECTIVE To investigate whether medication-overuse headache patients have differential DNA-methylation pattern. METHODS We collected blood samples from 120 medication-overuse headache-patients, 57 controls (29 episodic migraine patients and 28 healthy controls) in a hypothesis-generating cross-sectional case-control pilot study; 100 of the medication-overuse headache-patients were followed for six months and samples were collected at two and six months for the longitudinal methylation analyses. Blood cell proportions of leucocytes (neutrophils, NK-cells, monocytes, CD8+ and CD4+ T-cells, and B-cells) and the neutrophile-lymphocyte ratio were estimated using methylation data as a measure for immunological analysis and a cell type-specific epigenome wide association study was conducted between medication-overuse headache-patients and controls, and longitudinally for reduction in headache days/month among medication-overuse headache-patients. RESULTS We found a higher neutrophile-lymphocyte ratio in medication-overuse headache-patients compared to controls, indicating a higher immunological response in medication-overuse headache-patients (false discovery rate (adjusted p-value)<0.001). Reduction in headache days/month (9.8; 95% CI 8.1-11.5) was associated with lower neutrophile-lymphocyte ratio (false discovery rate adjusted p-value = 0.041).Three genes (CORIN, CCKBR and CLDN9) were hypermethylated in specific cell types in medication-overuse headache-patients compared to controls. No methylation differences were associated with reduction in headache days in medication-overuse headache-patients after six months. CONCLUSION This pilot study was consistent with higher immunological response in medication-overuse headache-patients which decreased with a reduction in headache days in longitudinal analysis. medication-overuse headache-patients exhibited differential methylation in innate immune cells but did not exhibit longitudinal differences with alterations in headache days. Our study creates hypotheses for further biomarker searches.ClinicalTrials.gov Identifier: NCT02993289.
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Affiliation(s)
| | | | | | - Thomas Mears Werge
- Novo Nordisk Foundation Center for Protein Research, Copenhagen University, Denmark
| | | | | | - Thomas Folkmann Hansen
- Danish Headache Center, Rigshospitalet, Denmark.,Novo Nordisk Foundation Center for Protein Research, Copenhagen University, Denmark
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2
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Gallardo VJ, Gómez-Galván JB, Asskour L, Torres-Ferrús M, Alpuente A, Caronna E, Pozo-Rosich P. A study of differential microRNA expression profile in migraine: the microMIG exploratory study. J Headache Pain 2023; 24:11. [PMID: 36797674 PMCID: PMC9936672 DOI: 10.1186/s10194-023-01542-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 01/27/2023] [Indexed: 02/18/2023] Open
Abstract
BACKGROUND Several studies have described potential microRNA (miRNA) biomarkers associated with migraine, but studies are scarcely reproducible primarily due to the heterogeneous variability of participants. Increasing evidence shows that disease-related intrinsic factors together with lifestyle (environmental factors), influence epigenetic mechanisms and in turn, diseases. Hence, the main objective of this exploratory study was to find differentially expressed miRNAs (DE miRNA) in peripheral blood mononuclear cells (PBMC) of patients with migraine compared to healthy controls in a well-controlled homogeneous cohort of non-menopausal women. METHODS Patients diagnosed with migraine according to the International Classification of Headache Disorders (ICHD-3) and healthy controls without familial history of headache disorders were recruited. All participants completed a very thorough questionnaire and structured-interview in order to control for environmental factors. RNA was extracted from PBMC and a microarray system (GeneChip miRNA 4.1 Array chip, Affymetrix) was used to determine the miRNA profiles between study groups. Principal components analysis and hierarchical clustering analysis were performed to study samples distribution and random forest (RF) algorithms were computed for the classification task. To evaluate the stability of the results and the prediction error rate, a bootstrap (.632 + rule) was run through all the procedure. Finally, a functional enrichment analysis of selected targets was computed through protein-protein interaction networks. RESULTS After RF classification, three DE miRNA distinguished study groups in a very homogeneous female cohort, controlled by factors such as demographics (age and BMI), life-habits (physical activity, caffeine and alcohol consumptions), comorbidities and clinical features associated to the disease: miR-342-3p, miR-532-3p and miR-758-5p. Sixty-eight target genes were predicted which were linked mainly to enriched ion channels and signaling pathways, neurotransmitter and hormone homeostasis, infectious diseases and circadian entrainment. CONCLUSIONS A 3-miRNA (miR-342-3p, miR-532-3p and miR-758-5p) novel signature has been found differentially expressed between controls and patients with migraine. Enrichment analysis showed that these pathways are closely associated with known migraine pathophysiology, which could lead to the first reliable epigenetic biomarker set. Further studies should be performed to validate these findings in a larger and more heterogeneous sample.
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Affiliation(s)
- V. J. Gallardo
- grid.430994.30000 0004 1763 0287Headache and Neurological Pain Research Group, Vall d’Hebron Institute of Research (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - J. B. Gómez-Galván
- grid.430994.30000 0004 1763 0287Headache and Neurological Pain Research Group, Vall d’Hebron Institute of Research (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - L. Asskour
- grid.430994.30000 0004 1763 0287Headache and Neurological Pain Research Group, Vall d’Hebron Institute of Research (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - M. Torres-Ferrús
- grid.430994.30000 0004 1763 0287Headache and Neurological Pain Research Group, Vall d’Hebron Institute of Research (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain ,grid.411083.f0000 0001 0675 8654Neurology Department, Headache Unit, Vall d’Hebron University Hospital, Barcelona, Spain
| | - A. Alpuente
- grid.430994.30000 0004 1763 0287Headache and Neurological Pain Research Group, Vall d’Hebron Institute of Research (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain ,grid.411083.f0000 0001 0675 8654Neurology Department, Headache Unit, Vall d’Hebron University Hospital, Barcelona, Spain
| | - E. Caronna
- grid.430994.30000 0004 1763 0287Headache and Neurological Pain Research Group, Vall d’Hebron Institute of Research (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain ,grid.411083.f0000 0001 0675 8654Neurology Department, Headache Unit, Vall d’Hebron University Hospital, Barcelona, Spain
| | - P. Pozo-Rosich
- grid.430994.30000 0004 1763 0287Headache and Neurological Pain Research Group, Vall d’Hebron Institute of Research (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain ,grid.411083.f0000 0001 0675 8654Neurology Department, Headache Unit, Vall d’Hebron University Hospital, Barcelona, Spain
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Frederiksen SD, Haanes KA, Warfvinge K, Edvinsson L. Perivascular neurotransmitters: Regulation of cerebral blood flow and role in primary headaches. J Cereb Blood Flow Metab 2019; 39:610-632. [PMID: 29251523 PMCID: PMC6446417 DOI: 10.1177/0271678x17747188] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 11/04/2017] [Accepted: 11/06/2017] [Indexed: 12/17/2022]
Abstract
In order to understand the nature of the relationship between cerebral blood flow (CBF) and primary headaches, we have conducted a literature review with particular emphasis on the role of perivascular neurotransmitters. Primary headaches are in general considered complex polygenic disorders (genetic and environmental influence) with pathophysiological neurovascular alterations. Identified candidate headache genes are associated with neuro- and gliogenesis, vascular development and diseases, and regulation of vascular tone. These findings support a role for the vasculature in primary headache disorders. Moreover, neuronal hyperexcitability and other abnormalities have been observed in primary headaches and related to changes in hemodynamic factors. In particular, this relates to migraine aura and spreading depression. During headache attacks, ganglia such as trigeminal and sphenopalatine (located outside the blood-brain barrier) are variably activated and sensitized which gives rise to vasoactive neurotransmitter release. Sympathetic, parasympathetic and sensory nerves to the cerebral vasculature are activated. During migraine attacks, altered CBF has been observed in brain regions such as the somatosensory cortex, brainstem and thalamus. In regulation of CBF, the individual roles of neurotransmitters are partly known, but much needs to be unraveled with respect to headache disorders.
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Affiliation(s)
- Simona D Frederiksen
- Department of Clinical Experimental Research, Glostrup Research Institute, Rigshospitalet Glostrup, Glostrup, Denmark
| | - Kristian A Haanes
- Department of Clinical Experimental Research, Glostrup Research Institute, Rigshospitalet Glostrup, Glostrup, Denmark
| | - Karin Warfvinge
- Department of Clinical Experimental Research, Glostrup Research Institute, Rigshospitalet Glostrup, Glostrup, Denmark
- Division of Experimental Vascular Research, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Lars Edvinsson
- Department of Clinical Experimental Research, Glostrup Research Institute, Rigshospitalet Glostrup, Glostrup, Denmark
- Division of Experimental Vascular Research, Department of Clinical Sciences, Lund University, Lund, Sweden
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4
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Kilic TY, Aksay E, Atilla OD, Sezik S, Camlar M. The diagnostic value of complete blood count parameters in patients with subarachnoid hemorrhage. Turk J Emerg Med 2018; 17:128-131. [PMID: 29464214 PMCID: PMC5812913 DOI: 10.1016/j.tjem.2017.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 06/21/2017] [Accepted: 07/18/2017] [Indexed: 11/17/2022] Open
Abstract
Objectives Diagnosis of subarachnoid hemorrhage (SAH) in patients presenting with headache is challenging and there has been any biomarker studied for excluding of SAH in those patients. We aim to determine the sensitivity of leukocytosis or left shift to exclude the diagnosis of SAH in ED patients presenting with headache. Method Adult patients with headache who received a computed tomography (CT) with the diagnosis of SAH and had a complete blood count (CBC) represent the case group, headache patients with normal CT and had a CBC represent the control group. The white blood cell (WBC) count and percentage of polymorphonuclear cells (PMNs%) taken during admission and within the first 6 and 12 h of admission were recorded. Results A hundred ninety seven patients with SAH and 197 patients without SAH were enrolled in to study. Sensitivity, specificity, NPV and PPV of leukocytosis or increase in PMNs% (left shift) in the diagnosis of SAH was 89.8% (84.5-93.5, 95% CI), 46.7% (39.6-53.9, 95% CI), 82.1% (73.5-88.4, 95% CI) and 62.8% (56.8-68.4, 95% CI) respectively on initial emergency department (ED) admission. Conclusion CBC should be considered as a noninvasive test for the exclusion of SAH in ED patients with 6 h observation.
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Affiliation(s)
- Turgay Yılmaz Kilic
- Izmir Tepecik Research and Educational Hospital, Department of Emergency Medicine, Izmir, Turkey
- Corresponding author. Department of Emergency Medicine, Tepecik Training and Research Hospital, Gaziler Caddesi, Yenisehir, 35120, Izmir, Turkey.Department of Emergency MedicineTepecik Training and Research HospitalGaziler CaddesiYenisehirIzmir35120Turkey
| | - Ersin Aksay
- Dokuz Eylul University Hospital, Department of Emergency Medicine, Izmir, Turkey
| | - Ozge Duman Atilla
- Izmir Tepecik Research and Educational Hospital, Department of Emergency Medicine, Izmir, Turkey
| | - Savas Sezik
- Izmir Tepecik Research and Educational Hospital, Department of Emergency Medicine, Izmir, Turkey
| | - Mahmut Camlar
- Izmir Tepecik Research and Educational Hospital, Department of Neurosurgery, Izmir, Turkey
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Blum CA, Winzeler B, Nigro N, Schuetz P, Biethahn S, Kahles T, Mueller C, Timper K, Haaf K, Tepperberg J, Amort M, Huber A, Bingisser R, Sándor PS, Nedeltchev K, Müller B, Katan M, Christ-Crain M. Copeptin for risk stratification in non-traumatic headache in the emergency setting: a prospective multicenter observational cohort study. J Headache Pain 2017; 18:21. [PMID: 28197843 PMCID: PMC5307398 DOI: 10.1186/s10194-017-0733-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Accepted: 02/07/2017] [Indexed: 11/10/2022] Open
Abstract
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.
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Affiliation(s)
- Claudine Angela Blum
- Division of Endocrinology, Department of Internal Medicine, University Hospital Basel, Basel, Switzerland. .,Internal Medicine, Medical University Clinic, Kantonsspital Aarau, Tellstrasse, CH-5001, Aarau, Switzerland.
| | - Bettina Winzeler
- Division of Endocrinology, Department of Internal Medicine, University Hospital Basel, Basel, Switzerland
| | - Nicole Nigro
- Division of Endocrinology, Department of Internal Medicine, University Hospital Basel, Basel, Switzerland
| | - Philipp Schuetz
- Internal Medicine, Medical University Clinic, Kantonsspital Aarau, Tellstrasse, CH-5001, Aarau, Switzerland
| | - Silke Biethahn
- Department of Neurology, Medical University Clinic, Kantonsspital Aarau, Aarau, Switzerland
| | - Timo Kahles
- Department of Neurology, Medical University Clinic, Kantonsspital Aarau, Aarau, Switzerland
| | - Cornelia Mueller
- Division of Endocrinology, Department of Internal Medicine, University Hospital Basel, Basel, Switzerland
| | - Katharina Timper
- Division of Endocrinology, Department of Internal Medicine, University Hospital Basel, Basel, Switzerland.,Max-Planck-Institute for Metabolism Research, Cologne, Germany
| | - Katharina Haaf
- Department of Neurology, Medical University Clinic, Kantonsspital Aarau, Aarau, Switzerland
| | - Janina Tepperberg
- Department of Neurology, Medical University Clinic, Kantonsspital Aarau, Aarau, Switzerland
| | - Margareth Amort
- Clinic of Neurology, University Hospital Basel, Basel, Switzerland
| | - Andreas Huber
- Center of Laboratory Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Roland Bingisser
- Emergency Department, University Hospital Basel, Basel, Switzerland
| | | | - Krassen Nedeltchev
- Department of Neurology, Medical University Clinic, Kantonsspital Aarau, Aarau, Switzerland
| | - Beat Müller
- Internal Medicine, Medical University Clinic, Kantonsspital Aarau, Tellstrasse, CH-5001, Aarau, Switzerland
| | - Mira Katan
- Clinic of Neurology, University Hospital Zürich, Zürich, Switzerland
| | - Mirjam Christ-Crain
- Division of Endocrinology, Department of Internal Medicine, University Hospital Basel, Basel, Switzerland
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Abstract
BACKGROUND A growing body of literature suggests that migraineurs, particularly those with aura, have an increased risk for ischemic stroke, but not via enhanced atherosclerosis. The theory that micro-emboli induced ischemia provokes cortical spreading depression (ie, symptomatic aura) in migraineurs but transient ischemic attacks in others highlights a potential role for hypercoagulability as a link between migraine (with aura) and stroke. AIM Our objective is to summarize the literature evaluating the association of migraine with various acquired or inheritable thrombophilic states, including those related to elevated estrogen levels, endothelial activation and dysfunction, antiphospholipid antibodies (aPL), deficiency of coagulation inhibitors, and presence of certain genetic polymorphisms. FINDINGS Although definitive studies are lacking, a preponderance of available evidence links migraine, and especially aura, to increased levels of estradiol (eg, oral contraceptive pill [OCP] use, pregnancy), thrombo- and erythrocytosis, von Willebrand factor (vWF) antigen, fibrinogen, tissue plasminogen activator (tPA) antigen, and endothelial microparticles. Studies of a link to migraine are conflicting for aPL, homocysteine, Protein S, and the methylenetetrahydrofolate reductase (MTHFR) C677T polymorphism. No association with migraine was found in meta-analyses of Factor V Leiden, and of prothrombin gene mutation. Within a large, young ischemic stroke sample, migraine with aura was associated with a thrombophilic state and with patent foramen ovale (PFO). In the non-stroke population, meta-analyses show an association of PFO and migraine with aura (MA), but two population-based studies do not support the link. RECOMMENDATIONS For persons with MA and (1) a personal history or family history of thrombosis, or (2) MRI evidence of micro-vascular ischemia or of stroke, an evaluation for hypercoagulability is warranted. In cases of MA alone, consider screening for markers of endothelial activation (eg, vWF, high sensitivity c-reactive protein [hs CRP], and fibrinogen). Rigorous management of other stroke risk factors is paramount, but efficacy of anti-thrombotic agents in the treatment of migraine is unproven. Closure of PFO is not routinely recommended based on negative randomized trials.
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Affiliation(s)
- Gretchen E Tietjen
- Department of Neurology, University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA
| | - Stuart A Collins
- Department of Neurology, University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA
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Valença MM, da Silva AA, Bordini CA. Headache Research and Medical Practice in Brazil: An Historical Overview. Headache 2015; 55 Suppl 1:4-31. [DOI: 10.1111/head.12512] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/18/2014] [Indexed: 12/28/2022]
Affiliation(s)
- Marcelo Moraes Valença
- Neurology and Neurosurgery Unit; Department of Neuropsychiatry; Federal University of Pernambuco; Recife Brazil
- Neurology and Neurosurgery Unit, Hospital Esperança; Brazil
| | - Amanda Araújo da Silva
- Neurology and Neurosurgery Unit; Department of Neuropsychiatry; Federal University of Pernambuco; Recife Brazil
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Abstract
It has been postulated that chronic pain and chronic migraine in particular, can be connected to immunologic disturbances. Moreover the psychiatric comorbidity is often responsible of migraine chronification, but also of developing of particular immune function alterations. The role of the immune system in migraine precipitation is still under debate also if speculations about the evidence of infections in migraine patients has been performed, but not always corroborated by clinical and scientific explanations. In this report we present an evaluation of specific immune parameters in patients suffering from different forms of migraine respect to controls in order to determine possible alterations in immune function: speculations about the evidenced abnormalities are attempted.
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10
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Lippi G, Cervellin G, Mattiuzzi C. Migraine and erythrocyte biology: a review. Int J Lab Hematol 2014; 36:591-7. [DOI: 10.1111/ijlh.12199] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2013] [Accepted: 01/31/2014] [Indexed: 02/01/2023]
Affiliation(s)
- G. Lippi
- Laboratory of Clinical Chemistry and Hematology; Academic Hospital of Parma; Parma Italy
| | - G. Cervellin
- Emergency Department; Academic Hospital of Parma; Parma Italy
| | - C. Mattiuzzi
- Service of Clinical Governance; General Hospital of Trento; Trento Italy
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