Assessment of Inflammation in Primary Headaches
Condition: Headache Disorders
MeSH terms: Tension-Type Headache; Headache Disorders; Inflammation; Headache
Study type: Observational [Patient Registry]

Summary: 
      Headache is the most common neurological complaint accounting for % 1 to % 4 in the emergency
      department (ED).Every year, nearly one million people with headache attacks have been
      consulted by healthcare professionals at the emergency room in the United States.The
      International Classification of Headache Disorders (ICHD) divided headaches into two main
      groups: primary headaches and secondary headaches. The vast majority of cases who presented
      with acute headache attack in ED had a diagnosis of primary headache disorders (tension- type
      headache, migraine, cluster- type headache, and other primary headaches). However, secondary
      headache is often associated with underlying intracranial pathologies, and noted in % 10 of
      cases in emergency rooms. Despite the frequent presence of primary headaches, limited time
      setting and busy periods of medical assessment, leading diagnostic and therapeutic options
      due to the pathophysiological factors to be overlooked.

      To date, no study in the emergency care setting has explored the role of inflammation in
      patients with acute migraine and TTH. Investigators aimed to explore inflammatory markers
      [white blood cells (WBC), neutrophil, lymphocyte, platelet, neutrophil / lymphocyte ratio
      (NLR), and platelet / lymphocyte ratio (PLR)] in complete blood count (CBC) among MA, MO, and
      TTH participants who admitted to ED with acute headache attack and healthy volunteers.
    

Detailed description: 
      Study design This prospective study was completed at an emergency care of a tertiary referral
      hospital between May 2018 and May 2019. The hospital admits a total of 45.000 adult emergency
      patients per year. This study was approved by the local ethics Committee of Kocaeli
      University (KOU/KAE: 2018/192) in accordance with the Helsinki Declaration. Written and
      informed consent form was obtained from all individual participants.

      Study population Investigators screened 720 patients who admitted to the ED with an acute
      headache attack. Clinical evaluation was performed by an experienced neurologist.
      Consequently, 51 patients with MA, 51 patients with MO, and 48 patients with TTH according to
      the diagnostic criterias of ICHD-3 and 80 age- and gender matched healthy controls were
      enrolled in this study. Detailed sociodemographic and clinical data collected using
      face-to-face interview. Visual analog scale (VAS) documented to measure the intensity of pain
      in patient groups.

      Investigators included adult participants aged between 18 and 65 years. Also, subjects were
      eligible for inclusion if their body mass index (BMI) ranges were between18 kg/m2 and 30
      kg/m2. Patients with secondary headaches, trauma, malignancy, chronic inflammatory disorders,
      infectious diseases, hematologic abnormalities, a prior history of surgery (within the
      preceding 6 months), receiving analgesics, antibiotics, blood transfusion and other blood
      products, were excluded from the study.

      Laboratory analysis Complete blood count (CBC) parameters [WBC, neutrophil, lymphocyte,
      platelet] of patients and control groups were obtained from 2 cc peripheral venous blood
      samples (purple K3 EDTA tubes, Beckman Coulter DXH 800 Analyzer) during admission. NLR and
      PLR were calculated by dividing absolute neutrophil to absolute lymphocyte count and absolute
      platelet to absolute lymphocyte count, respectively.

      Statistical Analysis SPSS 17.0 statistical software package program (IBM Corporation, USA)
      was used for the analysis. Descriptive data were presented using numbers, percentages (%) ,
      mean ± standard deviation. Categorical variables were analyzed by using chi-square (χ2) test.
      Normality tests (Shapiro-Wilks, Lilliefors, and Kolmogorov-Smirnov) were used for all
      parameters. Due to the non-normal distribution of CBC values, Kruskal-Wallis and Tamhane's T2
      post hoc tests were used to compare between patients with MA, MO, TTH, and healthy controls.
      A p value ≤ 0.05 considered statistically significant.
    

Intervention name(s): inflammation
Intervention type(s): Other
Intervention description(s): inflammatory values in complete blood count (CBC)
Observational model: Case-Control
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        Migraine and tension-type headache patients who admitted to emergency department with an
        acute headache attack
      
Keywords: primary headache; migraine with aura; migraine without aura; tension type headache; inflammation; neuroinflammation