Cerebrospinal Fluid (CSF) Investigations in Migraine

Abstract

A normal cell count as well as normal CSF pressure levels were found in both classic and common migraine patients during and between attacks. Total protein content was significantly lower in the migraine patients than in the controls, but no changes were found in the CSF protein fractions. The CSF 5-hydroxyindoleacetic acid level of the migraine patients proved to be higher than in the controls, whereas the homovanillic acid concentration was within the control limits.

Persistent Cerebrospinal Fluid Abnormalities in the Syndrome of Headache, Neurological Deficit, and Cerebrospinal Fluid Lymphocytosis Despite Resolution of Clinical Symptomatology

“…CSF pleocytosis has been reported in severe migraine, 10 but it is doubtful that CSF pleocytosis occurs in migraine with and without aura. [11][12][13] The patients reported in this series also had elevated opening pressure and elevated CSF protein, which has not been reported in migraine. 14 The persistence of CSF abnormalities despite clinical resolution appears to be unique to HaNDL syndrome.…”

“…The CSF abnormalities in HaNDL syndrome are characteristic, with all patients in this series having elevated opening pressure, elevated lymphocytes, and elevated protein, with normal glucose. CSF pleocytosis has been reported in severe migraine, 10 but it is doubtful that CSF pleocytosis occurs in migraine with and without aura 11‐13 . The patients reported in this series also had elevated opening pressure and elevated CSF protein, which has not been reported in migraine 14 …”

Chemical Mediators of Migraine: Preclinical and Clinical Observations

“…During a migraine attack, 5‐HT turnover increases significantly in the plasma 51,52 and saliva 53 . Additionally, increases in the levels of 5‐hydroxyindoleacetic acid, a major metabolite of 5‐HT, have also been reported in the cerebrospinal fluid of migraineurs during acute attacks 54 …”

Authors' reply

“…Many clinical features observed before, during and following migraine attacks have long been hypothesized to be related to dopaminergic activation. Plasma and platelet DA levels appear to be unchanged in migraine with and without aura subjects between attacks (11,12) and while cerebrospinal fluid levels of the DA metabolite DOPAC are raised during attacks (13), another metabolite (homovanillic acid) has been found to be normal both during and between attacks (14). Drugs with DA receptor effects are well known to have efficacy in both the acute and preventative treatment of migraine.…”