Diagnostic Accuracy of Serum Calcitonin Gene-Related Peptide and Apolipoprotein E in Migraine: A Preliminary Study

Abstract

Background A reliable, migraine-specific biomarker has not been identified so far. Calcitonin Gene-Related Peptide (CGRP) and Apolipoprotein E (ApoE) might serve as migraine biomarkers due to their roles in migraine pathophysiology. However, their diagnostic usefulness has not been explored yet. Present study explored the diagnostic accuracy of CGRP and ApoE in migraine. Methods A cross-sectional, case–control study was conducted from November 2019 to April 2020 at Physiology department of our university. Fourteen female migraine patients, 18–25 years old, with confirmed “Migraine” diagnosis by a neurologist, were recruited. Control group consisted of 14 age-matched healthy females with no personal/family history of migraine. Blood was drawn once from control subjects and twice from migraine patients (ictal and interictal phase). Serum CGRP and ApoE levels were assessed by ELISA. Statistical analysis involved paired t -test, one-way ANOVA, Receiver operating characteristic (ROC) curves and cross-tabs. Results ApoE (mg/dl) was higher significantly in interictal (1.90±0.50) and ictal (1.97±0.65) phases of migraine compared to control (1.07±0.26) (p ≤ 0.001). ROC curves for ApoE were significant in migraine ictal vs control (AUC= 0.91, AUC 95% CI: 0.78–1.0) and migraine interictal vs control (AUC=0.92, AUC 95% CI: 0.8–1.0) subjects. ROC curve for CGRP (pg/mL) was significant in migraine ictal vs control subjects only (AUC=0.79, AUC 95% CI: 0.6–0.97). Conclusion Serum ApoE has “excellent” accuracy to diagnose migraine patients whether in ictal or interictal phase, from healthy subjects. ApoE levels of patients in these two phases of migraine are raised significantly than healthy subjects. CGRP has “fair” diagnostic accuracy to discriminate between migraine ictal phase and healthy subjects. Its levels do not differ significantly among migraine ictal, interictal phase and healthy controls.

Biomarkers of Migraine: An Integrated Evaluation of Preclinical and Clinical Findings

“…Interestingly, a positive correlation between serum CGRP levels and pain intensity was also reported [ 41 ]. It must, however, be noted that other studies did not report any changes in CGRP levels among EM and CM patients [ 42 , 43 , 44 , 45 , 46 ].…”

“…Some studies clearly show an increase in plasma/saliva CGRP levels during the attack compared with the interictal period in EM patients [ 34 , 40 , 48 , 49 , 50 ]. By contrast, other studies reported no difference in CGRP levels in jugular venous blood between the ictal and interictal periods in EM subjects [ 45 , 51 ]. Similarly, Cady and colleagues showed no difference in the CGRP saliva levels of CM patients during a migraine attack compared with EM patients, suggesting that the threshold for central activation from peripheral input is possibly lower in CM than in EM [ 52 ].…”

Whole-Exome Sequencing Reveals Migraine-Associated Novel Functional Variants in Arab Ancestry Females: A Pilot Study

“…In Saudi Arabia, the prevalence of migraines in females is around 26.9% and is considered higher than the global average [ 6 , 7 ]. In addition, recent studies in this population revealed that high oestrogen levels could be involved in mediating the non-menstrual-related migraine among young Saudi females [ 8 ], and serum ApoE was reported as an excellent diagnostic marker for the same subjects with migraine in ictal or interictal phase [ 9 ]. However, genetic studies are deficient concerning migraines in this population [ 8 ].…”

“…It can also be classified into a chronic and episodic migraine. Hemiplegic migraine is another type of MA and is a severe and rare condition that affects one side of the body and causes temporary numbness [ 9 ]. It once was believed that migraine is a vascular disease; however, many recent types of research confirmed the involvement of multiple mechanisms related to the brain structures and processes [ 10 ].…”

Whole-exome sequencing reveals migraine associated novel functional variants

“…It can also be classi ed into chronic and episodic migraine. Hemiplegic migraine is another type of MA and is a severe and rare condition that affects one side of the body and causes temporary numbness [7]. The old theory on the cause of migraine considered it as a vascular disease; However, many recent researches con rmed the involvement of multiple mechanisms related to the brain structures and processes [8].…”