Amazingly, migraine still isn’t a well understood disease, both in public perception and scientifically. The past decade has seen progress in research, but there’s still a long way to go to understand the pathophysiology of migraine.
Identifying and validating biomarkers for migraine could help understand the pathophysiology of migraine, and that could lead to new treatment strategies and even to finally having diagnostic tests for migraine. Research in biochemical biomarkers has been rapidly growing. Promising biomarkers have been found for narcolepsy, Alzheimer’s disease, and Parkinson’s disease. Cerebrospinal fluid (CSF) has been a target of this research for brain disorders because CSF in though to show biochemical changes in the brain. A newly released study looks at possible CSF biomarkers for migraine.
“To perform a meta-analysis of migraine biomarkers in cerebrospinal fluid (CSF) and of corresponding blood concentrations.”
- Researchers conducted a systematic search for studies that measured biochemical compounds in CSF of patients with episodic migraine or chronic migraine as well as control patients with no headache disorder.
- Subsequently, researchers retrieved studies with blood measurements of selected CSF biomarkers.
- Results for compounds assessed in three or more studies were pooled in a meta-analysis with standardised mean differences (SMD) as effect measures.
- Researchers reviewed 1,197 articles, 40 of which were considered relevant to this study.
- Sixty-two compounds were measured in the 40 CSF studies.
- The most important results include:
- increased glutamate (five studies),
- calcitonin gene-related peptide (CGRP) (three studies), and
- nerve growth factor (NGF) (three studies) in chronic migraine patients and
- decreased b-endorphin (b-EP) in both chronic (four studies) and interictal episodic migraine patients (three studies).
- In blood, glutamate (interictal) and CGRP (chronic, interictal and ictal) were increased and b-EP (chronic, interictal and ictal) was decreased.
- "This is the ï¬rst meta-analysis of biochemical measurements in cerebrospinal ï¬‚uid (CSF) and blood from chronic and episodic migraine patients.
- A total of 62 unique compounds have been measured in CSF from migraine patients.
- Glutamate, calcitonin gene-related peptide and nerve growth factor (NGF) concentrations are increased and b-endorphin concentrations are decreased in CSF from migraine patients.
- These changes are also present in blood, with the exception of NGF.
- The presented data identify clear biomarker targets for future pathophysiological or diagnostic studies on migraine."
“Glutamate, b-EP, CGRP and NGF concentrations are altered in CSF and, except for NGF, also in blood of migraineurs. Future research should focus on the pathophysiological roles of these compounds in migraine.”
Summary and Implications for Patients:
All of the terms can make this study a bit hard for a layperson to digest, but the study highlights and conclusions are pretty clear. This type of review and meta-analysis can be very valuable in pulling together data from smaller studies and showing their value when connected.
This study points to the importance of identifying migraine biomarkers, which can lead to a better understanding of the pathophysiology of migraine. There are two major implications for patients:
- Identifying migraine biomarkers and understanding the pathophysiology of migraine better could help lead to better targeted treatments.
- Identifying migraine biomarkers and understanding the pathophysiology of migraine better could help lead to finally having definitive diagnostic tests for migraine.
More Helpful Information:
van Dongen, Robin M.; Zielman, Ronald; Noga, Maren; Dekkers, Olaf M.; Hankemeier, Thomas; van den Maagdenbert, Arn MJM; Terwindt, Gisela M.; Ferrari, Michel D. “Migraine biomarkers in cerebrospinal fluid: A systematic review and meta-analysis.” Cephalalgia. Published online before print February 17, 2016.
**Reviewed by David Watson, MD.
Teri Robert is a leading patient educator and advocate and the author of Living Well with Migraine Disease and Headaches. A co-founder of the Alliance for Headache Disorders Advocacy and the American Headache and Migraine Association, she received the National Headache Foundation’s Patient Partners Award and a Distinguished Service Award from the American Headache Society. Teri can be found on her website, and blog, Facebook, Twitter, StumbleUpon, Pinterest, LinkedIn, and Google+.