Comorbid and co-occurring diseases are risk factors for the progression of episodic migraine to chronic migraine. Biomarkers for migraine could help with diagnosis and treatment selection and monitoring. Aim. To examine the role of the plasma level of calcitonin-gene-related peptide (CGRP) in the diagnosis of episodic migraine in combination with comorbid conditions in the form of cervicalgia and psychoemotional disorders. Materials and methods. The study included 112 patients (84 women, 28 men; mean age 18-58 years), episodic migraine with typical aura – 17, without aura – 60. Patients were divided into 3 groups: I – episodic migraine with cervicalgia (n = 42), II – episodic migraine only (n = 35), III – cervicalgia only (n = 35). The Visual Analogue Scale, Migraine Disability Assessment (MIDAS) score, Headache Impact Test (HIT-6), Neck Disability Index, State-Trait Anxiety Inventory, Beck’s Depression Inventory and the number of days with headache were assessed. The control group consisted of 30 healthy persons to compare the level of CGRP. The serum level of CGRP was determine by enzyme-linked immunosorbent assay using the sandwich ELISA principle. Results. Plasma level of CGRP was higher in groups I and II compared with group III (P = 0.012543), where it did not differ from the control (51.48 ± 5.08 pg/ml). The highest level of CGRP was observed in group I (242.98 ± 5.08 pg/ml) in comparison with group II (145.82 ± 15.38 pg/ml, P = 0.000341). Co-occurring neck-pain in patients with episodic migraine was associated with mood and anxiety disorders. Migraine severity, according to the MIDAS score, was most significantly influenced by plasma level of CGRP, severity of subjective and objective symptoms of headache by the HIT-6, level of State-anxiety and Trait-anxiety, number of days with headache during the last 3 months. Conclusions. The serum level of CGRP is a reliable diagnostic and differential diagnostic laboratory biomarker for episodic migraine. Additional painful syndrome such as cervicalgia influences CGRP level and daily activity, mood and anxiety disorders in episodic migraine patients.
Migraine is the most common neurological disease that significantly affects a person's health and ability to work [1]. It is often accompanied by comorbidities and co-occurring conditions. Patients with migraine have a high frequency of myofascial pain syndrome of head and neck muscles [2,3, 4]. Differential diagnosis of migraine and cervicogenic headache is complicated by a significant combination of symptoms.
Objective — to study the diagnostic significance of the serum level of calcitonin‑gene‑related peptide as a tool for the differential diagnosis of migraine with comorbid neck pain and tension of the pericranial muscles and cervicogenic headache. Methods and subjects. The study included 112 patients (84 women, 28 men) aged from 18 to 58 years. In 77 patients episodic migraine was diagnosed (with a typical aura in 17 and without aura in 60 patients), in 35 patients suffered from cervicalgia with muscle‑tonic syndromes and cervicogenic headache. Among patients with migraine, 42 had concomitant cervicalgia with muscle‑tonic dysfunction. The examined patients were distributed into 3 clinical groups: I — combination of episodic migraine with cervicalgia, II — episodic migraine, III — cervicalgia without migraine. In all patients, pain intensity was assessed using a visual analogue scale, the effect of migraine on daily activity and performance using the MIDAS and HIT‑6 scales, and the Neck Disability Index. The control group for comparing the serum level of CGRP consisted of 30 clinically healthy persons. The serum level of CGRP was determined by enzyme‑linked immunosorbent assay using the sandwich ELISA principle. Results. In the group of patients with a combination of episodic migraine with cervicalgia and cervicogenic headache, compared with the group with isolated migraine, the number of days with headache over the last 3 months was higher (р < 0.001), the influence of headache on daily activity and performance according to the MIDAS scales and HIT‑6 was more significant (both р < 0.001) and the number of combined analgesics used was higher (р < 0.001). Plasma level of CGRP was statistically significantly higher in patients with episodic migraine compared with the group with cervicalgia without migraine (р < 0.05), where it did not differ from the control. The CGRP level was statistically significantly higher in women with migraine compared to men (р < 0.001), but did not differ in patients with migraine with and without aura (р > 0.05). Conclusions. The serum level of calcitonin‑gene‑related peptide is a reliable diagnostic and differential diagnostic laboratory biomarker of episodic migraine. The presence of concomitant cervicalgia in patients with episodic migraine significantly affects the level of CGRP in the blood plasma and the course of the disease (an increase in the number of days with headache, the amount of analgesic use, decreased performance and daily activity).
The aim: To determine the influence of co-occurring neck pain with cervical myofascial dysfunction on the development of psychoemotional disorders and the number of analgesics taken in patients with episodic migraine. Materials and methods: The study included 92 patients, 24 male and 68 female, mean age 42.5±15.5 years. Three groups were identify based on type headache: 1) both episodic migraine and cervicogenic headache with neck pain; 2) episodic migraine only; 3) neck pain only. Visual analogue scale (VAS) for pain syndrome, Migraine Disability Assessment (MIDAS) score, Headache Impact Test (HIT-6), Neck Disability Index, State-Trait Anxiety Inventory (STAI), Beck’s Depression Inventory (BDI) and numbers days with analgesics intake were assessment. Results: In patients, who suffered on episodic migraine combine with cervicogenic headache and neck pain number days with headache was more (p=0.000052), intensity attack was higher (p=0.003750) and number days with analgesics intake was greater (p=0.000003), compare with group with migraine only. The depression and anxiety state was more significant in patients with migraine and co-occurring neck pain comparable with migraine alone, but we found no significance differences between groups with migraine with neck pain and neck pain only. We observed significant correlation between STAI and Neck Disability Index (r=-0.5155), Neck Disability Index and HIT-6 (r=-0.4819). No correlation found between VAS for migraine, MIDAS and STAI and BDI. Conclusions: Our study demonstrate, that co-occurring neck pain in patients with episodic migraine increasing of numbers days with headache, negatively impacts on mood disorders, daily activity and associated with greater acute analgesics use.
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