No association between blood-based markers of immune system and migraine status: a population-based cohort study

Migraine is a common and complex neurological disorder that has a high impact on quality of life. Recent advances with drugs that target the neuropeptide calcitonin gene-related peptide (CGRP) have helped, but treatment options remain insufficient. CGRP is released from trigeminal sensory fibers and contributes to peripheral sensitization, perhaps in part due to actions on immune cells in the trigeminovascular system. In this review, we will discuss the potential of cannabinoid targeting of immune cells as an innovative therapeutic target for migraine treatment. We will cover endogenous endocannabinoids, plant-derived phytocannabinoids and synthetically derived cannabinoids. The focus will be on six types of immune cells known to express multiple cannabinoid receptors: macrophages, monocytes, mast cells, dendritic cells, B cells, and T cells. These cells also contain receptors for CGRP and as such, cannabinoids might potentially modulate the efficacy of current CGRP-targeting drugs. Unfortunately, to date most studies on cannabinoids and immune cells have relied on cell cultures and only a single preclinical study has tested cannabinoid actions on immune cells in a migraine model. Encouragingly, in that study a synthetically created stable chiral analog of an endocannabinoid reduced meningeal mast cell degranulation. Likewise, clinical trials evaluating the safety and efficacy of cannabinoid-based therapies for migraine patients have been limited but are encouraging. Thus, the field is at its infancy and there are significant gaps in our understanding of the impact of cannabinoids on immune cells in migraine. Future research exploring the interactions between cannabinoids and immune cells could lead to more targeted and effective migraine treatments.

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Serial Systemic Immune Inflammation Indices: Markers of Acute Migraine Events or Indicators of Persistent Inflammatory Status?

Wijeratne,

Murphy,

Wijeratne

et al. 2024

Preprint

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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 systemic immune-inflammatory indices as a measure of duration and severity of inflammation derived from relative blood cell counts in migraine patients within an acute inpatient setting. Specifically, we assessed the role of serial white blood cell counts to calculate Serial Systemic Immune-Inflammatory Indices (SSIIi) (calculated using the formula: neutrophil count x platelet count/lymphocyte count) between aura (N = 67) and no-aura (N = 119) migraine patients at time of admission to a tertiary care centre in Melbourne, Australia, and at 24 hours post admission versus stable in-community migraineur controls (N = 20) Main Body: We conducted a retrospective analysis of medical records from patients presenting with migraine at Western Health over an 18-month period. Patients were categorized as having migraine with aura (MA) or without aura (MO) according to ICHD-3 criteria. Baseline demographics and brain imaging findings were evaluated for each group. Patients who had at least two sets of white blood cell counts drawn within 24 hours during their admission were included in the study. 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) with similar blood measures. Conclusion SSIIi levels were significantly lower in patients with migraine with aura (MA), who also showed a greater, though non-significant, decrease between the two measurements compared to those with migraine without aura (MO) and 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 the acuity of presentation. Further studies are needed to evaluate the role of systemic inflammation in migraine pathophysiology, chronicity, and progression.

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No association between blood-based markers of immune system and migraine status: a population-based cohort study

Cited by 3 publications

References 27 publications

Migraine and Cardiovascular Risk in Women

Migraine and Cardiovascular Risk in Women

Interplay between cannabinoids and the neuroimmune system in migraine

Serial Systemic Immune Inflammation Indices: Markers of Acute Migraine Events or Indicators of Persistent Inflammatory Status?

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