Study Objectives: Migraine is a complex neurovascular disease and is believed to be due to a mixture of genetic and environmental factors. Study design: This was a cross-sectional observational prospective hospital based study conducted on 100 participants. They were divided into two groups; Group A: 50 migrainous patients according to the criteria of the International Classification of Headache Disorders and Group B: 50 healthy subjects both groups were age and sex matched. All subjects underwent a full neurological and psychiatric examination. Full headache evaluation sheet used in headache outpatient clinic in Ain Shams University Hospitals and HIT-6™ Headache Impact Test was used. Assay of serum level of N-acetyl-aspartate (NAA) as mitochondrial function marker was done. Results: There was no significant difference between both groups regarding gender, age or age group, marital state, education, residence and special habits. However, there was a statistical significant difference as regards family history of migraine more in patient group. In this study, serum NAA levels in migraine patients were significantly lower than in healthy controls. Decreased NAA level is generally believed to be a sign of reduced neuronal and glial mitochondrial function. Also, migraine with aura patients showed lower NAA levels when compared to migraine without aura subtypes. However, there was no significant correlation was found between NAA serum levels, and gender, age at onset, age group, type of aura, duration of the illness, type of onset of pain, frequent site of pain, time to max severity, severity of attack, and daily functions (social life, work, psychological wellbeing, sleep and cognition). Conclusions: Findings of this study indicate that NAA in serum may be a marker for neuronal dysfunction predisposing to migraine, probably related to the reduced mitochondria function.

Dermatomyositis (DM) is a rheumatological disorder characterized by proximal myositis and distinctive dermatological manifestations. It can be an isolated clinical syndrome or, in rarer cases, can be the initial presentation for an underlying malignancy as a part of a paraneoplastic syndrome. In this case report, we describe a case of a 51-year-old lady who presented with proximal myopathy, typical DM skin rash, dysphagia, and markedly elevated creatine kinase. She was diagnosed with a seronegative DM and her malignancy screening revealed a mass in the ascending colon. During her hospital course, she also developed microangiopathic hemolytic anemia, another paraneoplastic disorder typically associated with late stages of malignancy, manifested as hemolytic anemia, thrombocytopenia, and low fibrinogen. The patient received intravenous corticosteroids and underwent tumor resection with following resolution of her both rheumatological and hematological manifestation. Unfortunately, due to her general poor health, she developed sepsis and died in the hospital.