One of the issues migraine researchers have been looking at for quite some time is finding a biomarker for migraine disease. A biomarker is "a distinctive biological or biologically derived indicator (as a biochemical metabolite in the body) of a process, event, or condition."4 Identifying a biomarker for migraine could be a step toward a test to diagnose migraine.
A new study may be the first step toward identifying a biomarker for episodic migraine. Study author B. Lee Peterlin, DO, with the Johns Hopkins University School of Medicine in Baltimore, stated:
“While more research is needed to confirm these initial findings, the possibility of discovering a new biomarker for migraine is exciting.”2
In this study, 52 women with episodic migraine and 36 women who did not have any headache disorders underwent a neurologic exam, had their body mass index measured and gave blood samples. Women with migraine had an average of 5.6 migraine days per month. The blood samples were tested for a group of lipids that participate in energy homeostasis and that help to regulate inflammation in the brain.
The study found that:
- The total levels of the lipids called ceramides were decreased in women with episodic migraine as compared to those women without any headache disorders.
- Women with migraine had approximately 6,000 nanograms per milliliter of total ceramides in their blood, compared to women without headache who had about 10,500 nanograms per milliliter.
- Every standard deviation increase in total ceramide levels was associated with over a 92 percent lower risk of having migraine.
- Additionally, and in contrast to the ceramides, two other types of lipids, called sphingomyelin, were associated with a 2.5 times greaterrisk of migraine with every standard deviation increase in their levels.
The researchers also tested the blood of a random small sample of 14 of the participants for a panel of these lipids and were able to correctly identify those who had migraine or who were controls without headache based on these blood lipid levels.
Study limitations noted by the authors:
- The study sample size was relatively small, and larger studies to validate these findings of this study are needed.
- The study looked at patients with episodic migraine only.
- This study did not capture differences across the menstrual cycle.
- The researchers didn't attempt to evaluate all ceramide precursors and metabolites or to evaluate any of the enzymes that participate in ceramide anabolism and catabolism
The study authors concluded, in part:
"Taken together, our findings suggest it is possible that migraine is a neurologic disorder of “minor” sphingolipid dysmetabolism. Further research, validating the ceramide and sphingomyelin associations with migraine, as well as research examining mechanisms for these associations, may advance our understanding of migraine pathophysiology and open possibilities of the identification of novel migraine biomarkers and targeted drug therapies directed against sphingolipid pathways."1
In an accompanying comment piece, Karl Ekbom, MD, PhD, with the Karolinska Institutet in Stockholm, Sweden, said:
"This study is a very important contribution to our understanding of the underpinnings of migraine and may have wide-ranging effects in diagnosing and treating migraine if the results are replicated in further studies."
Ekbom also noted that a comparison should be made in future studies with other types of headache, such as cluster headache and listed limitations of the study:
- Only women were included.
- Chronic migraine was not studied
- An unusually high amount of participants had migraine with aura.
Comments and Implications for Patients:
Is this the first step toward a diagnostic test for migraine? It's too soon to tell, but it's certainly encouraging. In addition to the possibility of a definitive diagnostic test, this study may have revealed information about the pathophysiology of migraine that could lead to more targeted treatments. It will be interesting to watch for larger and broader studies that this one is certain to inspire.
More Helpful Information:
1 Peterlin, B. Lee, DO; Mielke, Michelle M., PhD; Dickens, Alex M., PhD; Chatterjee, Subroto, PhD; Dahs, Paul, MD; Alexander, Guillermo, PhD; Vieira, Rebeca, MSc; Bandaru, Veera Venkata Ratnam, PhD; Dorskind, Joelle M., BSc; Tietjen, Gretchen, MD; Haughey, PhD. "Interictal circulating sphingolipids in women with episodic migraine." Neurology® 2015;85:1–10.
2 Press Release. "A New Marker for Migraine?" American Academy of Neurology. September 9, 2015.
Ekbom, Karl, MD, PhD. "Comment: Altered sphingolipid metabolism - A marker for episodic migraine?" Neurology® 2015;85.
4Merriam-Webster Medical Dictionary