Adiponectin and leptin levels in migraineurs in the Atherosclerosis Risk in Communities Study

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.

Serological Biomarkers of Chronic Migraine

PURPOSE OF REVIEW

Chronic migraine (CM) is a chronic form of migraine that differs from episodic migraine (EM) in terms of prevalence, comorbidities, response to treatment, and biomarkers. The aim of this review was to summarize the recent findings on serological biomarkers of CM.

RECENT FINDINGS

Neuronal, inflammatory, and vascular markers have been investigated to assess their diagnostic and prognostic ability and treatment effectiveness. Several markers showed significant alterations according to disease status and treatment response in CM. Calcitonin gene-related peptide (CGRP), glutamate, and adiponectin appear to be the most promising blood biomarkers for CM. Most studies have shown altered ictal and interictal levels of these markers in CM compared with those in EM and controls. Additionally, they showed a significant association with treatment outcomes. Total adiponectin and high-molecular-weight adiponectin levels were less studied as biomarkers of CM than CGRP and glutamate levels but showed promising results. The development of suitable biomarkers could revolutionize the diagnosis and treatment of CM and ultimately decrease the disability and societal costs of the disease.

Is there any association between migraine headache and polycystic ovary syndrome (PCOS)? A review article

BACKGROUND

Polycystic ovary syndrome (PCOS) and migraine headaches are considered to be common health problems that may share some risk factors. This study aimed to discuss the possible association between migraine headache and polycystic ovary syndrome.

METHODS AND RESULTS

In this narrative review, PubMed, Scopus, Web of Science, and Google Scholar were systematically searched for retrieving and summarizing published studies up to January 2021 to explore the possible interplay between migraine headache and PCOS. We discuss the possible pathways that may explain the association between migraine headaches and PCOS signs/symptoms and complications. While genetic factors have profound effects on the pathogenesis of migraine headaches, sex hormones, including estrogen and progesterone may also play an important role in inducing migraine headaches. Some disorders, such as sleep apnea, amenorrhea, and vascular disease that are more likely to occur in women with PCOS, may cause or exacerbate migraine headaches in women with PCOS.

CONCLUSIONS

Future comprehensive studies are needed to investigate the exact underlining mechanisms related to the association between PCOS and migraine headaches.

The role of a potential biomarker in patients with migraine: review and new insights

Introduction: The search for an ideal biomarker for migraine has persisted for a long time. There is plentiful evidence of potential biomarkers for migraine found in cerebrospinal fluid, blood, and saliva.Areas covered: Herein, the authors highlight and discuss the most promising candidates in the literature. An electronic search was performed for studies published between 2010 and 2020 in MEDLINE, PubMed, and EMBASE, related to potential biomarkers in migraine patients, found in cerebrospinal fluid, saliva, and serum, focusing on biomarkers that can be related to treatment and clinical outcomes.Expert opinion: An ideal biomarker, or a panel of biomarkers, could revolutionize the way we address and propose treatments for this disease. Once severe presentations and phenotypes have been identified using a reliable biomarker, patients could be treated at earlier disease stages with more specific medications. The most important biomarkers with the most significant levels of evidence comprised calcitonin gene-related peptide (CGRP), glutamate, nerve growth factor, some inflammatory (CRP, TNF-α, interleukins) and oxidative stress markers. CGRP was associated with episodic, chronic migraine and response to treatment. Pituitary adenylate cyclase-activating polypeptide is an emerging neuropeptide involved in migraine diagnostics and severity. New genetic and epigenetic biomarkers will be candidates for future research.

Headache in Children: Selected Factors of Vascular Changes Involved in Underlying Processes of Idiopathic Headaches

Headaches are common complaints in children. The International Classification of Headache Disorders, 3^rd edition (beta version), defines more than 280 types of headaches. Primary headaches refer to independent conditions that cause pain and include migraine, tension-type headaches (TTH), and trigeminal autonomic cephalalgias (TACs). Several agents are involved in the pathogenesis of headaches. The factors associated with predisposition to atherosclerosis seem to be particularly important from the clinical point of view. The influence of obesity on the incidence of headaches has been well established. Moreover, idiopathic headaches, especially migraine, are thought to be one of the first signs of disorders in lipid metabolism and atherosclerosis. The risk of migraine increases with increasing obesity in children. Another factor that seems to be involved in both obesity and headaches is the adiponectin level. Recent data also suggest new potential risk factors for atherosclerosis and platelet aggregation such as brain-derived neurotrophic factor (BDNF), sCD40L (soluble CD40 ligand), serpin E1/PAI I (endothelial plasminogen activator inhibitor), and vascular endothelial growth factor (VEGF). However, their role is controversial because the results of clinical studies are often inconsistent. This review presents the current knowledge on the potential markers of atherosclerosis and platelet aggregation, which may be associated with primary headaches.

Adiponectin and leptin levels in migraineurs: Results from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil)

Background:

Relationships of adipokines (ADP) with migraine are not well-established. We examined the relationship of adiponectin and leptin with migraine by aura symptoms.

Methods:

In a baseline cross-sectional data of Brazilian Longitudinal Study of Adult Health (ELSA-Brasil), associations of ADP levels and migraine were assessed in a sample of 257 nondiabetic subjects, free from cardiovascular disease. Associations of ADP tertiles (dependent variable) and migraine status were tested using logistic regression models. Categories of migraine were created as follows: no headache (reference), migraine with aura (MA), and migraine without aura (MO) in all sample and by sex. Odds ratio (OR) with respective 95% confidence interval (CI) adjusted for age, sex, body mass index, and metabolic syndrome.

Results:

Among participants (46 years ± SD: 4.8), 47.5% were women and 36.2% had migraine (16.7% MA). Median values of leptin (ng/mL) increased gradually across subgroup: no headache: 9.5 (interquartile range (IQR): 5.5–15.7) versus MO: 17.0 (IQR: 10.9–34.2) versus MA: 20.9 (IQR: 11.7–29.3), overall p value <0.0001, but not for adiponectin levels. After full adjustment, the third of leptin was positively associated with MA (OR 2.89 (1.00–8.4)) and the second of adiponectin was associated with MO (OR 2.76; 95% CI: 1.09–6.96, p = 0.03). Positive associations with MA, second (OR 3.81; 95% CI: 1.07–13.59; p = 0.04) and third tertile of leptin (6.54; 95% CI: 1.74–24.57, p = 0.005), were also observed in women, but not in men.

Conclusions:

Positive associations between ADP and migraine, particularly between MA and leptin levels in women, raise the possibility of adipocytokines and play a role in migraine pathophysiology.

Circulating Biomarkers in Migraine: New Opportunities for Precision Medicine

Background:

Migraine is the most common neurological disorder and the second most disabling human condition, whose pathogenesis is favored by a combination of genetic, epigenetic, and environmental factors. In recent years, several efforts have been made to identify reliable biomarker(s) useful to monitor disease activity and/or ascertain the response to a specific treatment.

Objective:

To review the current evidence on the potential biological markers associated with migraine.

Methods:

A structured search of peer-reviewed research literature was performed by searching major publications databases up to December 2017.

Results:

Several circulating biomarkers have been proposed as diagnostic or therapeutic tools in migraine, mostly related to migraine’s inflammatory pathophysiological aspects. Nonetheless, their detection is still a challenge for the scientific community, reflecting, at least in part, disease complexity and clinical diagnostic limitations. At the present time, calcitonin generelated peptide (CGRP) represents probably the most promising candidate as a diagnostic and/or therapeutic biomarker, as its plasma levels are elevated during migraine attack and decrease during successful treatment. Other molecules (including some neuropeptides, cytokines, adipokines, or vascular activation markers) despite promising, do not possess the sufficient prerequisites to be considered as migraine biomarkers.

Conclusion:

The characterization of migraine-specific biomarkers would be fundamental in a perspective of precision medicine, enabling risk assessment and tailored treatments. However, speculating on the clinical validity of migraine biomarkers may be premature and controlled clinical trials are presently needed to investigate both the diagnostic and therapeutic value of these biomarkers in migraine.

Leptin, adiponectin, and resistin blood adipokine levels in migraineurs: Systematic reviews and meta-analyses

INTRODUCTION

Migraine comorbidity with obesity is not new and studies have focused on how adipose tissue-derived substances such as adipokines might be involved in the migraine pathophysiology. Quantification of the nature and magnitude of the association between each adipokine including leptin, adiponectin and resistin with migraine pathophysiology is the objective of the current study.

METHODS

Using systematic reviews and meta-analyses and standardized mean difference as effect size, the levels of three adipokines, leptin, adiponectin and resistin, have been investigated in migraineur subjects in the case-control studies.

RESULTS

Using random-effects models, the final analyses demonstrated the standardized mean differences of leptin, adiponectin and resistin as 0.534 (95% confidence interval, 0.169-0.898), 0.439 (95% confidence interval, 0.132-0.746) and 0.194 (95% confidence interval, -0.158-0.546), respectively. The p-value for test of significance for each pooled standardized mean difference was examined by the z-test and calculated as 0.004, 0.005 and 0.281 for leptin, adiponectin and resistin (clearly considered as statistically significant, significant and non-significant), respectively.

CONCLUSION

Based on the findings, the blood levels of leptin and adiponectin, but not resistin, of the migraineurs are associated with disease pathogenesis.

Is Migraine Primarily a Metaboloendocrine Disorder?

PURPOSE OF THE REVIEW

The goals of this review are to evaluate recent studies regarding comorbidity between migraine and different metabolic and endocrine disorders and to discuss the role of insulin resistance as a common pathogenetic mechanism of these diseases.

RECENT FINDINGS

Recently, several studies showed that migraine is associated with insulin resistance, a condition in which a normal amount of insulin induces a suboptimal physiological response. All the clinical studies that used the oral glucose tolerance test to examine insulin sensitivity found that, after glucose load, there is in migraine patients a significant increase of both plasmatic insulin and glucose concentrations in comparison with controls. On the contrary, no association was found between migraine and type 2 diabetes, while type 1 diabetes seems to have a protective effect in the disease. Obesity and hypertension were shown to be risk factors for both episodic and chronic migraine. Metabolic syndrome has been recently associated mainly with migraine with aura and is now considered a risk factor also for medication overuse headache. Finally, a bidirectional association between migraine and hypothyroidism has been recently demonstrated, suggesting that common genetic or autoimmune mechanisms underlie both diseases. Recent studies showed that insulin receptor signaling and the related physiological responses are altered in migraine and may have a relevant pathogenic role in the disease. Further studies are warranted in order to better elucidate mechanisms underlying insulin resistance in migraine in order to develop new therapeutic strategies for this debilitating disease.

The role of leptin as a biomarker in the relationship between periodontitis and chronic migraine

AIM

To evaluate the prevalence of periodontitis (CP) and its contribution to serum leptin levels in chronic migraine (CM).

MATERIAL AND METHODS

In this case-control study, we included 150 subjects divided into healthy controls (n = 58) and CM patients (n = 92). Demographic, neurological, clinical data as well as full-mouth periodontal records were obtained. Serum leptin levels were measured by ELISA technique.

RESULTS

Both the prevalence of CP and mean serum leptin levels were significantly higher in patients with CM in comparison with controls (57.6% versus 36.2%, p = .01 and 16.4 versus 7.2 ng/ml, p < .0001, respectively). Patients from the CM group who had CP showed significantly higher leptin concentrations than CM patients without CP (19.8 versus 11.8 ng/ml, p < .0001). Multivariable linear regression analysis showed that CP was an independent contributor to raised leptin levels in CM patients (R²  = 0.270, p = 0.013).

CONCLUSIONS

CP is prevalent in CM patients and when present it contributes to elevated serum leptin levels, independently of other confounding factors. Therefore, it seems that CP via leptin could be involved in the process of migraine chronification.

Role of adipocytokines in the pathophysiology of migraine: A cross-sectional study

Background Obesity is a risk factor for migraine and headache chronification. Adipocytokines may be involved in this correlation. Objective To relate serum adipocytokine levels to clinical and biochemical parameters associated with migraine. Methods We measured levels of leptin, adiponectin and other inflammatory (interleukin 6, interleukin 10, tumor necrosis factor α, high sensitivity C-reactive protein) and endothelial (pentraxin 3, soluble TNF-like weak inducer of apoptosis) molecules potentially related to migraine pathophysiology in a group of migraine patients (IHS 2013) and healthy controls. Results One hundred and eleven patients (mean age 39.7 years, 93% female) and 24 healthy controls (mean age 35.9 years, 90% female) were included. Fifty-six patients were diagnosed with episodic migraine (mean age 35.1 years, 98.2% female) and 55 patients with chronic migraine (mean age 44.4 years, 89.5% female). Leptin serum levels (15.2 ng/mL, SD = 10.5 vs . 3.1 ng/mL, SD = 0.9; p < 0.001) and adiponectin serum levels (72.3 µg/mL, SD = 38.5 vs . 37.7 µg/mL, SD = 16.9; p < 0.001) were significantly increased in migraine patients. Leptin serum levels (15.5 ng/mL, SD = 9.7 vs . 10.8 ng/mL, SD = 6.0; p < 0.001) and adiponectin serum levels (65.8 µg/mL, SD = 42.9 vs . 33.2 µg/mL, SD = 31.0; p < 0.001) were significantly higher in chronic compared to episodic migraine patients. We found a positive correlation between leptin levels and inflammatory biomarkers: IL6 (r = 0.498; p < 0.001), TNF-α (r = 0.389; p < 0.001), and hs-CRP (r = 0.422; p < 0.001). Conclusions Leptin and adiponectin are increased in migraineurs. There is a correlation between adipocytokine levels and other inflammation-related molecules. This suggests a potential role of adipocytokines in migraine pathophysiology and chronification.

The link between obesity and migraine in childhood: a systematic review

Obesity and headache are two highly prevalent diseases both in adults and children and they are associated with a strong personal and social impact. Many studies suggest that obesity is comorbid with headache in general, and migraine in particular and obesity seems to be a risk factor for migraine progression and for migraine frequency both in adults and in children. Research shows that there are multiple areas of overlap between migraine pathophysiology and the central and peripheral pathways regulating feeding: inflammatory mediators such as the calcitonin gene-related protein (CGRP), neurotransmitters such as serotonin, peptides such as orexin and adipocytokines such as adiponectin (ADP) and leptin could explain the common pathogenesis. In this paper we discussed the association between obesity and migraine through the analysis of the most recent studies in children and we reviewed data from literature in order to assess the association between obesity and headache and to clarify the possible common pathogenic mechanisms.

Investigating the role of adipokines in chronic migraine

Background and aims

Adiponectin, leptin, and resistin are adipocyte-derived secretory factors involved in endothelial function, weight, inflammation, and insulin resistance. Recent studies suggested a role for adipokines in episodic migraine as mediators of inflammatory processes. The aim of this study was to investigate plasma concentrations of adiponectin, leptin, and resistin in patients with chronic migraine.

Materials and methods

Twenty-seven chronic migraineurs (20 females, 7 males; mean age 49.0 ± 9.0 yrs) and 37 healthy controls (23 females, 14 males; mean age 49.8 ± 15.0 yrs) were selected for the study. Fasting plasmatic levels of total adiponectin, leptin, and resistin were measured using ELISA kits during a pain-free period. Fasting glucose, insulin, total and HDL-cholesterol, triglycerides, and ESR were also determined.

Results

Serum levels of adiponectin and resistin were significantly increased in chronic migraineurs in comparison with controls ( p = 0.001 and p = 0.032, respectively). After correction for BMI, sex and age, leptin levels were significantly increased in chronic migraineurs ( p = 0.007). A positive correlation between leptin concentrations and both indices of insulin resistance and markers of inflammation was found.

Discussion

Our data suggest that adiponectin and resistin are altered in non-obese chronic migraineurs. Further studies are needed to elucidate the neurobiological mechanisms underlying adipokine dysfunction in migraine.

Diet and nutraceutical interventions for headache management: A review of the evidence

Background

The use of complementary and alternative medicines (CAM) is common among patients with primary headaches. In parallel, CAM research is growing. Diet interventions comprise another category of non-pharmacologic treatment for primary headache that is of increasing clinical and research interest.

Methods

A literature search was carried out to identify studies on the efficacy of diet and nutraceutical interviews for primary headache in the pediatric and adult populations. MEDLINE, Embase and EBM Reviews—Cochrane Central Register of Controlled Trials were searched to identify studies.

Results

There is a growing body of literature on the potential use of CAM and diet interventions for primary headache disorders. This review identified literature on the use of a variety of diet and nutraceutical interventions for headache. Most of the studies assessed the efficacy of these interventions for migraine, though some explored their role in tension-type headache and cluster headache. The quality of the evidence in this area is generally poor.

Conclusions

CAM is becoming more commonplace in the headache world. Several interventions show promise, but caution needs to be exercised in using these agents given limited safety and efficacy data. In addition, interest in exploring diet interventions in the treatment of primary headaches is emerging. Further research into the efficacy of nutraceutical and diet interventions is warranted.

High leptin levels are associated with migraine with aura

Background Migraine is a prevalent disorder characterised by recurrent headache attacks preceded or accompanied by aura in a subgroup of patients. Migraine often occurs together with major depressive disorder (MDD). Alterations of adipokine levels have been reported both in migraine and in MDD. In this cross-sectional study, we aimed to assess the associations between serum leptin and adiponectin levels and migraine or migraine subtypes. Analyses were adjusted for a lifetime history of MDD in order to investigate the association between adipokines and migraine under consideration of depression status. Methods We included 3025 participants from the CoLaus/PsyCoLaus study. The impact of leptin and adiponectin levels on a diagnosis of migraine was analysed by binary regression analyses, adjusting for variables known to influence adipokine levels. Subgroup analyses were conducted based on the presence of aura. Results Crude leptin levels were significantly higher in subjects with migraine than controls (Mann-Whitney U = 515,102, p = 6 × 10^-7). When performing adjusted analyses, leptin levels were found to be significantly higher in subjects with migraine (odds ratio = 1.22, p = 0.024) and migraine with aura (odds ratio = 1.34, p = 0.004). Conclusion High leptin levels might play a role in the pathogenesis of migraine and migraine with aura.

Adipokines and Migraine: A Systematic Review

BACKGROUND

Migraine is comorbid with obesity. Recent research suggests an association between migraine and adipocytokines, proteins that are predominantly secreted from adipose tissue and which participate in energy homeostasis and inflammatory processes.

OBJECTIVES

In this review, we first briefly discuss the association between migraine and obesity and the importance of adipose tissue as a neuroendocrine organ. We then present a systematic review of the extant literature evaluating circulating levels of adiponectin and leptin in those with migraine.

METHODS

A search of the PubMed database was conducted using the keywords "migraine," "adiponectin," and "leptin." In addition reference lists of relevant articles were reviewed for possible inclusion. English language studies published between 2005 and 2015 evaluating circulating blood concentration of adiponectin or leptin in those with migraine were included.

CONCLUSIONS

While the existing data are suggestive that adipokines may be associated with migraine, substantial study design differences and conflicting results limit definitive conclusions. Future research utilizing carefully considered designs and methodology is warranted. In particular careful and systematic characterization of pain states at the time of samples, as well as systematic consideration of demographic (e.g., age, sex) and other vital covariates (e.g., obesity status, lipids) are needed to determine if adipokines play a role in migraine pathophysiology and if any adipokine represents a viable, novel migraine biomarker, or drug target.

Interictal, circulating sphingolipids in women with episodic migraine: A case-control study

OBJECTIVE

To evaluate interictal, circulating sphingolipids in women migraineurs.

METHODS

In the fasting state, serum samples were obtained pain-free from 88 women with episodic migraine (EM; n=52) and from controls (n=36). Sphingolipids were detected and quantified by high-performance liquid chromatography coupled with tandem mass spectrometry using multiple reaction monitoring. Multivariate logistic regression was used to examine the association between serum sphingolipids and EM odds. A recursive partitioning decision tree based on the serum concentrations of 10 sphingolipids was used to determine the presence or absence of EM in a subset of participants.

RESULTS

Total ceramide (EM 6,502.9 ng/mL vs controls 10,518.5 ng/mL; p<0.0001) and dihydroceramide (EM 39.3 ng/mL vs controls 63.1 ng/mL; p<0.0001) levels were decreased in those with EM as compared with controls. Using multivariate logistic regression, each SD increase in total ceramide (odds ratio [OR] 0.07; 95% confidence interval [CI]: 0.02, 0.22; p<0.001) and total dihydroceramide (OR 0.05; 95% CI: 0.01, 0.21; p<0.001) levels was associated with more than 92% reduced odds of migraine. Although crude sphingomyelin levels were not different in EM compared with controls, after adjustments, every SD increase in the sphingomyelin species C18:0 (OR 4.28; 95% CI: 1.87, 9.81; p=0.001) and C18:1 (OR 2.93; 95% CI: 1.55, 5.54; p=0.001) was associated with an increased odds of migraine. Recursive portioning models correctly classified 14 of 14 randomly selected participants as EM or control.

CONCLUSION

These results suggest that sphingolipid metabolism is altered in women with EM and that serum sphingolipid panels may have potential to differentiate EM presence or absence.

CLASSIFICATION OF EVIDENCE

This study provides Class III evidence that serum sphingolipid panels accurately distinguish women with migraine from women without migraine.