Plasma levels of inflammatory mediators in vestibular migraine

Association between milk consumption and migraines among American adults: national health and nutrition examination survey

BACKGROUND

Migraines have been associated with nutritional imbalances within the brain, sparking ongoing interest in the possible association between dietary elements, including milk intake, and the occurrence of migraines. Nevertheless, the exact nature of the connection between milk consumption and migraines remains unclear.

METHODS

This cross-sectional analysis sought to explore the association between milk intake and the prevalence of migraines. The study utilized data from individuals aged 20 and above who participated in the National Health and Nutrition Examination Survey from 1999 to 2004. In our study, we meticulously gathered comprehensive data on severe headaches or migraines, milk consumption, along with critical variables such as age, sex, marital status, and body mass index, among others. Milk consumption among participants was ascertained through a questionnaire. Logistic regression modeling and subgroup analyses were employed to evaluate the association between milk consumption and the incidence of severe headaches or migraines.

RESULTS

Among the 8850 participants, 19.98% (1768/8850) were identified as having migraines. Compared to individuals with only regular/whole milk consumption in the past 30 days, the adjusted OR values for only skim milk consumption in the past 30 days were 0.73 (95%CI: 0.60-0.89, p = 0.001), 0.78 (95%CI: 0.64-0.95, p = 0.014), and 0.77 (95%CI: 0.63-0.93, p = 0.009), respectively.

CONCLUSION

A notable association was detected between the type of milk intake and the occurrence of migraines. These results lay the groundwork for future investigations into the role of milk consumption in migraine management, potentially informing strategies for alleviating migraine symptoms.

No change in interictal plasma and salivary CGRP levels in individuals with vestibular migraine corresponding to episodic migraine

BackgroundFew studies have examined plasma calcitonin gene-related peptide (CGRP) levels in individuals with vestibular migraine (VM), with inconsistent findings. Additionally, salivary CGRP levels in VM have not been reported.MethodsInterictal plasma and salivary CGRP levels were measured using an enzyme-linked immunosorbent assay in participants with VM corresponding to episodic migraine (VM, n = 81), chronic migraine without vestibular symptoms (CM, n = 73) and healthy controls (HC, n = 59).ResultsPlasma CGRP levels in VM with episodic migraine participants were significantly lower than those in participants with CM (median = 37.1 pg/mL, interquartile range (IQR) = 22.4-60.4 pg/mL vs. median = 74.6 pg/mL, IQR  = 49.6-101.6 pg/mL; p < 0.001) but did not significantly differ from levels in HC. Similarly, salivary CGRP levels were also significantly lower in VM compared to CM (median = 54.5 pg/mL, IQR = 37.0-83.4 pg/mL vs. median = 72.0 pg/mL, IQR  = 56.5-96.2 pg/mL; p = 0.036), with no significant difference observed between VM and HC. Receiver operating characteristic analysis showed that plasma CGRP levels effectively differentiated CM from VM corresponding to episodic migraine, achieving an area under the curve of 0.88. No significant correlations were found between plasma or salivary CGRP levels and clinical features of CM and VM.ConclusionsInterictal plasma and salivary CGRP levels are unlikely to serve a biomarkers for VM.

Serial systemic immune inflammation indices: markers of acute migraine events or indicators of persistent inflammatory status?

BACKGROUND

Migraine is the most common complex neurological disorder, affecting over a billion people worldwide. Neurogenic inflammation has long been recognized as a key factor in the pathophysiology of migraine though little research has been directed to investigating whether inflammation is greatest in migraine with aura or without, and whether inflammation is a permanent state in migraine or whether is an event related transitory state. Thus, the primary aim of this single-centre, retrospective study was to explore the potential clinical utility of the Serial Systemic Immune-Inflammatory Indices (SSIIi) as a comparative measure of duration and severity of inflammation derived from routine blood cell counts in migraine patients with aura and no-aura both within an acute inpatient setting and as outpatients. Specifically, we assessed the role of two serial white blood cell counts to calculate the SSIIi using the formula: neutrophil count x platelet count/lymphocyte count) between aura and no-aura migraine patients at time of admission to a tertiary care centre in Melbourne, Australia, and following 24 h post admission versus comparable serial measures in 20 out patients with migraine and ongoing symptoms.

MAIN BODY

A retrospective analysis was conducted of medical records using baseline demographics and brain imaging findings from 186 migraine hospitalized in-patients who had at least two sets of white blood cell counts drawn within 24 h following their admission to the emergency department of Western Health a tertiary care center in Melbourne, Australia, over an 18-month period. Patients were categorized as having migraine with aura (MA) (N = 67) or without aura (MO) (N = 119) according to ICHD-3 criteria and compared to 2 serial measures in stable in-community acute migraineur controls (N = 20). A mixed-design ANOVA showed a significant main effect of SSIIi between patients with migraine with aura (MA) and migraine without aura (MO) during acute inpatient presentation, in comparison to a convenience sample of outpatients with migraine (MA and MO).

CONCLUSION

SSIIi levels were significantly lower in patients with migraine with aura (MA), compared to MO. MA showed a greater, though non-significant, decrease between the two measurements compared to those with migraine without aura (MO) and outpatient controls, whose SSIIi levels remained consistently higher. The control group displayed similar findings to MO inpatients, suggesting persistent systemic inflammation in a subset of migraine patients regardless of in patient or outpatient of presentation and highlighting the need for future studies to more rigorously evaluate the role of systemic inflammation in migraine pathophysiology, chronicity, and progression though the multiple phases of migraine including the interictal phase.

Vestibular Migraine Patient Assessment Tool and Handicap Inventory (VM-PATHI) : A narrative review

BACKGROUND

Vestibular migraine (VM) has a wide range of clinical presentations that can have a significant negative impact on quality of life. Currently, there is no objective test available to confirm the diagnosis or measure the severity of VM. The only available tools for assessing disease severity are patient-reported outcome measures (PROMs), such as the Dizziness Handicap Inventory (DHI).

OBJECTIVE

This manuscript aims to summarize the current knowledge about a newly developed PROM called the Vestibular Migraine Patient Assessment Tool and Handicap Inventory (VM-PATHI).

METHODS

A comprehensive search was conducted across the Web of Science, Scopus, PubMed, and Google Scholar databases up to February 2024, using the keywords "Vestibular migraine," "VM-PATHI," and "Patient-Reported Outcome Measure." Only studies involving human participants were included, and no additional restrictions were applied. The reference lists of included studies were also reviewed to identify other eligible studies. The main outcome of interest was the evaluation of VM-PATHI in patients with VM.

RESULTS

The VM-PATHI is a 25-item questionnaire divided into six sections: headache equivalents, motion sensitivity, anxiety, cognition, disequilibrium/central audiovestibular disturbance, and emotion/sense of being overwhelmed. This tool has demonstrated good face and content validity, discriminant validity, responsiveness, test-retest reliability, and internal reliability (Cronbach's α: 0.92). Patients with VM are likely to show clinical improvement in symptoms if their VM-PATHI scores decrease by ≥6 points. Additionally, VM-PATHI has shown a good correlation with clinical improvement across various treatment modalities.

CONCLUSION

The VM-PATHI may provide advantages over other PROMs by measuring a wider spectrum of disease-specific effects of VM. Scores are correlated with the DHI, dizzy days per month, and other quality of life metrics.

Immunohistochemical Identification of Sensory Neuropeptides Calcitonin Gene-Related Peptide, Substance P, and Pituitary Adenylate Cyclase-Activating Polypeptide in Efferent Vestibular Nucleus Neurons

INTRODUCTION

The efferent vestibular system (EVS) originates in brainstem efferent vestibular nuclei (EVN) and modifies afferent vestibular signals at their source, in peripheral vestibular organs. Recent evidence suggests that EVS is also involved in the development of motion sickness symptoms, including vertigo and nausea, but the underlying mechanism is unknown. One possible link between EVN and motion sickness symptoms is through the neuropeptide calcitonin gene-related peptide (CGRP). CGRP often co-exists with substance P and pituitary adenylate cyclase-activating polypeptide (PACAP), two neuropeptides with similar vasodilatory effects. Collectively, these sensory neuropeptides have been associated with vestibular migraine pathophysiology and motion sickness. While CGRP and the fast EVS neurotransmitter, acetylcholine (ACh), have previously been identified in EVN neurons and their peripheral terminals, the presence of substance P and PACAP in the EVN has not yet been described.

METHODS

We used fluorescent immunohistochemistry combined with confocal microscopy to examine the distribution of these three neuropeptides in the mouse EVN. In transgenic choline acetyltransferase (ChAT)-gCaMP6f mice, EVN neurons were positively identified using the fluorescent expression of gCaMP6f. In wild-type C57/BL6 mice, EVN neurons were confirmed using ChAT immunolabelling.

RESULTS

Consistent with previous studies, CGRP was labelled in a subset of cholinergic EVN neurons. Additionally, we also show evidence for substance P and PACAP expression in EVN of transgenic and wild-type mice.

CONCLUSION

The presence of CGRP, substance P, and PACAP in EVN neurons suggests a complex peptidergic modulation of cholinergic signalling, whose release into local blood vessels may contribute to motion sickness symptoms.

Intranasal administration of recombinant human BDNF as a potential therapy for some primary headaches

BACKGROUND

In addition to its critical role in neurogenesis, brain-derived neurotrophic factor (BDNF) modulates pain and depressive behaviors.

METHODS

In a translational perspective, we tested the anti-migraine activity of highly purified and characterized recombinant human BDNF (rhBDNF) in an animal model of cephalic pain based on the chronic and intermittent NTG administration (five total injections over nine days), used to mimic recurrence of attacks over a given period. To achieve this, we assessed the effects of two doses of rhBDNF (40 and 80 µg/kg) administered intranasally to adult male Sprague-Dawley rats, on trigeminal hyperalgesia (by orofacial formalin test), gene expression (by rt-PCR) of neuropeptides and inflammatory cytokines in specific areas of the brain related to migraine pain. Serum levels of CGRP, PACAP, and VIP (by ELISA) were also evaluated. The effects of rhBDNF were compared with those of sumatriptan (5 mg/kg i.p), administered 1 h before the last NTG administration.

RESULTS

Both doses of rhBDNF significantly reduced NTG-induced nocifensive behavior in Phase II of the orofacial formalin test. The anti-hyperalgesic effect of intranasal high-dose rhBDNF administration in the NTG-treated animals was associated with a significant modulation of mRNA levels of neuropeptides (CGRP, PACAP, VIP) and cytokines (IL-1beta, IL-10) in the trigeminal ganglion, medulla-pons, and hypothalamic area. Of note, the effects of rhBNDF treatment were comparable to those induced by the administration of sumatriptan. rhBDNF administration at both doses significantly reduced serum levels of PACAP, while the higher dose also significantly reduced serum levels of VIP.

CONCLUSIONS

The findings suggest that intranasal rhBDNF has the potential to be a safe, non-invasive and effective therapeutic approach for the treatment of primary headache, particularly migraine.

Focused Update on Migraine and Vertigo Comorbidity

PURPOSE OF REVIEW

To provide an update on comorbidity of vestibular symptoms and migraine.

RECENT FINDINGS

Multisensory processing and integration is a key concept for understanding mixed presentation of migraine and vestibular symptoms. Here, we discuss how vestibular migraine should be distinguished from a secondary migraine phenomenon in which migraine symptoms may coincide with or triggered by another vestibular disorder. We also have some updates on the diagnostic criteria of vestibular migraine, its pathophysiology, and common approaches used for its treatment. As a common clinical presentation of migraine and vestibular symptoms, vestibular migraine should be distinguished from a secondary migraine phenomenon, in which migraine symptoms may be triggered by or coincide with another vestibular disorder. Recent experimental evidence suggests vestibular symptoms in vestibular migraine are linked to multisensory mechanisms that control body motion and orientation in space.

Altered immunity in migraine: a comprehensive scoping review

BACKGROUND

The pathogenesis of migraine remains unclear; however, a large body of evidence supports the hypothesis that immunological mechanisms play a key role. Therefore, we aimed to review current studies on altered immunity in individuals with migraine during and outside attacks.

METHODS

We searched the PubMed database to investigate immunological changes in patients with migraine. We then added other relevant articles on altered immunity in migraine to our search.

RESULTS

Database screening identified 1,102 articles, of which 41 were selected. We added another 104 relevant articles. We found studies reporting elevated interictal levels of some proinflammatory cytokines, including IL-6 and TNF-α. Anti-inflammatory cytokines showed various findings, such as increased TGF-β and decreased IL-10. Other changes in humoral immunity included increased levels of chemokines, adhesion molecules, and matrix metalloproteinases; activation of the complement system; and increased IgM and IgA. Changes in cellular immunity included an increase in T helper cells, decreased cytotoxic T cells, decreased regulatory T cells, and an increase in a subset of natural killer cells. A significant comorbidity of autoimmune and allergic diseases with migraine was observed.

CONCLUSIONS

Our review summarizes the findings regarding altered humoral and cellular immunological findings in human migraine. We highlight the possible involvement of immunological mechanisms in the pathogenesis of migraine. However, further studies are needed to expand our knowledge of the exact role of immunological mechanisms in migraine pathogenesis.

Vestibular function is associated with immune inflammatory response

Association between vestibular function and immune inflammatory response has garnered increasing interest. Immune responses can lead to anatomical or functional alterations of the vestibular system, and inflammatory reactions may impair hearing and balance. Vestibular disorders comprise a variety of conditions, such as vestibular neuritis, benign paroxysmal positional vertigo, Meniere's disease, vestibular migraine, posterior circulation ischemia, and bilateral vestibular disease. Moreover, some patients with autoimmune diseases develop vestibulocochlear symptom. This paper offers an overview of prevalent vestibular diseases and discusses associations between vestibular dysfunction and immune diseases.

Experimental and Clinical Investigation of Cytokines in Migraine: A Narrative Review

The role of neuroinflammation in the pathophysiology of migraines is increasingly being recognized, and cytokines, which are important endogenous substances involved in immune and inflammatory responses, have also received attention. This review examines the current literature on neuroinflammation in the pathogenesis of migraine. Elevated TNF-α, IL-1β, and IL-6 levels have been identified in non-invasive mouse models with cortical spreading depolarization (CSD). Various mouse models to induce migraine attack-like symptoms also demonstrated elevated inflammatory cytokines and findings suggesting differences between episodic and chronic migraines and between males and females. While studies on human blood during migraine attacks have reported no change in TNF-α levels and often inconsistent results for IL-1β and IL-6 levels, serial analysis of cytokines in jugular venous blood during migraine attacks revealed consistently increased IL-1β, IL-6, and TNF-α. In a study on the interictal period, researchers reported higher levels of TNF-α and IL-6 compared to controls and no change regarding IL-1β levels. Saliva-based tests suggest that IL-1β might be useful in discriminating against migraine. Patients with migraine may benefit from a cytokine perspective on the pathogenesis of migraine, as there have been several encouraging reports suggesting new therapeutic avenues.

Cytokines in primary headache disorders: a systematic review and meta-analysis

BACKGROUND

The role of inflammation and cytokines in the pathophysiology of primary headache disorders is uncertain. We performed a systematic review and meta-analysis to synthesise the results of studies comparing peripheral blood cytokine levels between patients with migraine, tension-type headache, cluster headache, or new daily persistent headache (NDPH), and healthy controls; and in migraine between the ictal and interictal stages.

METHODS

We searched PubMed/Medline and Embase from inception until July 2022. We included original research studies which measured unstimulated levels of any cytokines in peripheral blood using enzyme-linked immunosorbent assay or similar assay. We assessed risk of bias using the Newcastle-Ottawa Quality Assessment Scale. We used random effects meta-analysis with inverse variance weighted average to calculate standardised mean difference (SMD), 95% confidence intervals, and heterogeneity for each comparison. This study is registered with PROSPERO (registration number CRD42023393363). No funding was received for this study.

RESULTS

Thirty-eight studies, including 1335 patients with migraine (32 studies), 302 with tension-type headache (nine studies), 42 with cluster headache (two studies), and 1225 healthy controls met inclusion criteria. Meta-analysis showed significantly higher interleukin (IL)-6 (SMD 1.07, 95% CI 0.40-1.73, p = 0.002), tumour necrosis factor (TNF)-α (SMD 0.61, 95% CI 0.14-1.09, p = 0.01), and IL-8 (SMD 1.56, 95% CI 0.03-3.09, p = 0.04), in patients with migraine compared to healthy controls, and significantly higher interleukin-1β (IL-1β) (SMD 0.34, 95% CI 0.06-0.62, p = 0.02) during the ictal phase of migraine compared to the interictal phase. Transforming growth factor (TGF)-β (SMD 0.52, 95% CI 0.18-0.86, p = 0.003) and TNF-α (SMD 0.64, 95% CI 0.33-0.96, p = 0.0001) were both higher in patients with tension-type headache than controls.

CONCLUSIONS

The higher levels of the proinflammatory cytokines IL-6, IL-8 and TNF-α in migraine compared to controls, and IL-1β during the ictal stage, suggest a role for inflammation in the pathophysiology of migraine, however prospective studies are required to confirm causality and investigate the mechanisms for the increase in cytokine levels identified. Cytokines may also have a role in tension-type headache. Due a lack of data, no conclusions can be made regarding cluster headache or NDPH.

The role of cytokines in migraine: A systematic review

BACKGROUND

Cytokines are important endogenous substances that are involved in immune and inflammatory responses. Neurogenic inflammation has been proposed to play a role in migraine involving altered cytokine levels. Therefore, we aimed to provide a systematic review on the current knowledge on cytokine levels in migraine patients during and outside attacks.

METHODS

Databases of PubMed and Embase were systematically searched for studies investigating cytokine levels in migraine patients during and outside attacks.

RESULTS

Screening yielded identification of 45 articles investigating 18 cytokines in total. We found that the interictal level of the anti-inflammatory cytokine, interleukin 10, was decreased, while the level of transforming growth factor beta 1 was increased in migraine patients compared to controls. Levels of pro-inflammatory cytokines, tumor necrosis factor α and interleukin 6, were increased outside attacks compared to controls. Ictal levels of cytokines were unchanged or varying compared to the interictal state in migraine patients. Three studies reported dynamic cytokines levels during the course of an attack.

CONCLUSION

The findings of the current review underline a possible involvement of cytokines in the proposed inflammatory mechanisms of migraine. However, future studies are needed to expand our knowledge of the exact role of cytokines in the migraine pathophysiology with focus on cytokines TNF-α, IL-1ß, IL-6 and IL-10 while applying refined methodology.

Vestibular migraine treatment: a comprehensive practical review

Vestibular migraine is an underdiagnosed but increasingly recognised neurological condition that causes episodic vertigo associated with other features of migraine. It is now thought to be the most common cause of spontaneous (non-positional) episodic vertigo, affecting up to 1% of the population. A meta-analysis of preventative treatments for vestibular migraine was published in 2021 but the authors were unable to establish a preferred treatment strategy due to low quality of evidence and heterogeneity of study design and outcome reporting. There remains therefore a clinical need for pragmatic management guidelines specific to vestibular migraine using the available evidence. Here we provide a practical review utilising a systematic qualitative assessment of the evidence for abortive and preventative interventions in adults. The overall evidence base for vestibular migraine treatment is of low quality. Nevertheless, we provide practical treatment recommendations based on the available evidence and our experience to help guide clinicians treating patients with vestibular migraine. We also discuss how future clinical trials could be designed to improve the quality of evidence in this condition.

Exogenous Hsp70 attenuates nitroglycerin-induced migraine-like symptoms in mice

Although the connection between heat shock protein 70 (HSP70) and vestibular migraine is not clear, HSP70 is neuroprotective in other scenarios. This study aimed to investigate the potential of exogenous HSP70 for treating migraine-like symptoms in a mouse model of nitroglycerin (NTG)-induced migraine. HSP70 levels were assessed in patients with vestibular migraine and healthy individuals by ELISA. Migraine was induced in mice by NTG, and HSP70 expression was examined in the trigeminal nucleus caudalis (TNC) tissue of mice treated with NTG and NTG together with exogenous HSP70. The effects of exogenous HSP70 on migraine-like symptoms were assessed through behavioral assays. Finally, the impact of HSP70 on oxidative stress and NF-κB signaling in mice with migraine was investigated. Serum HSP70 in patients with vestibular migraine was significantly lower than that of healthy individuals. NTG administration significantly suppressed HSP70 expression in mouse TNC tissue, which was reversed by exogenous HSP70. HSP70 alleviated NTG-induced mechanical hypersensitivity, light aversion, and anxiety-like behavior. Finally, exogenous HSP70 suppressed NTG-induced oxidative stress and NF-κB signaling. Our study suggests that exogenous HSP70 may be a potential therapy for alleviating migraine symptoms and our promising finding warrants further investigation of HSP70 for clinical application.NEW & NOTEWORTHY The study suggests that exogenous HSP70 may be a potential therapy for alleviating migraine symptoms and our promising finding warrants further investigation of HSP70 for clinical application.

Resistance exercise relieves symptoms of vestibular migraine patients with MRI diagnosis: A randomized parallel-controlled single-blind clinical trial

To investigate the efficacy of resistance exercise on symptoms of vestibular migraine (VM) among migraine patients, a total of 385 VM patients were recruited, among whom 312 were eligible to participate in the current study. Patients were randomly allocated into either resistance exercise or relaxation control groups, and received respective interventions two times per week for 12 weeks. Patients were followed up at two and four months, respectively, to evaluate treatment effects. Primary outcomes included Dizziness Handicap Inventory (DHI), the number of vertiginous attacks in the previous week and Vertigo Severity Scale (VSS). Secondary endpoints included depression and anxiety symptoms, which were measured using the scores of the Beck Anxiety Inventory (BAI) and the Beck Depression Inventory (BDI). Serum concentrations of pro-inflammatory cytokines, including tumor necrosis factor-α (TNF-α) and interferon-γ (IFN-γ), were also assessed. Resistance exercise was slightly more pronounced in alleviating VM symptoms than relaxation control at two-month follow-up. While at four-month follow-up, the extents of the symptom attenuation were obviously better in the resistance exercise group than the relaxation control, in terms of VSS and DHI scores, as well as BDI and BAI scores. Serum levels of both TNF-α and IFN-γ were also significantly lower in patients in the resistance group than those in the relaxation control group. Our study favors an exercise-oriented treatment scheme in rehabilitating therapy for patients suffering from VM, and sheds light on the molecular mechanism potentially involving TNF-α and IFN-γ related inflammation pathways.

Involvement of TRPM2 in the Neurobiology of Experimental Migraine: Focus on Oxidative Stress and Apoptosis

Excessive Ca²⁺ influx and mitochondrial oxidative stress (OS) of trigeminal ganglia (TG) have essential roles in the etiology of migraine headache and aura. The stimulation of TRPM2 channel via the generation of OS and ADP-ribose (ADPR) induces pain, inflammatory, and oxidative neurotoxicity, although its inhibition reduces the intensity of pain and neurotoxicity in several neurons. However, the cellular and molecular effects of TRPM2 in the TG of migraine model (glyceryl trinitrate, GTN) on the induction of pain, OS, apoptosis, and inflammation remain elusive. GTN-mediated increases of pain intensity, apoptosis, death, cytosolic reactive oxygen species (ROS), mitochondrial ROS, caspase -3, caspase -9, cytosolic Ca²⁺ levels, and cytokine generations (TNF-α, IL-1β, and IL-6) in the TG of TRPM2 wild-type mouse were further increased by the TRPM2 activation, although they were modulated by the treatments of GSH, PARP-1 inhibitors (PJ34 and DPQ), and TRPM2 blockers (ACA and 2APB). However, the effects of GTN were not observed in the TG of TRPM2 knockout mice. The current data indicate that the maintaining activation of TRPM2 is not only important for the quenching OS, inflammation, and neurotoxicity in the TG neurons of mice with experimental migraine but also equally critical to the modulation of GTN-induced pain.

Do we need to reconsider the classification of vestibular migraine?

Introduction: Vestibular migraine (VM) is a complex disease characterized by recurrent episodes of migraine associated with vertigo attacks that are observed in 1-3% of the general population. Given its high prevalence and the impact on the health system, it is important to characterize these patients, in order to offer an accurate diagnosis and a proper treatment. As the diagnosis of VM is based on clinical features, the study of potential biomarkers has gained more interest in the last years, to improve the precision in the diagnosis of this disease. The aim of this review is to summarize the main tests available for the diagnosis of VM, including the accuracy of biomarkers for the diagnosis of VM.Areas covered: This review summarizes the main information on VM, including all diagnosis records published in the field in the last 10 years, and focusing on candidate biomarkers for the diagnosis of VM patients.Expert opinion: There is a limited knowledge in the pathophysiology of VM. The search of biomarkers for diagnosis of VM is needed to improve the precision in the diagnosis promoting clinical and translational research. The potential reclassification of VM will depend upon the discovery and validation of these biomarkers.