The Link Between Human Cytomegalovirus Gene Expression and Glutamate Level in Migraine;Relation to Vitamin D Deficiency

1. To correlate serum 25(OH)-vitamin D level with duration, frequency, and severity of migraine headache attacks
2. To evaluate the relationship between the serum level of vitamin D and other indices in patients with migraine.
3. To correlate the serum level of glutamate with gene expression of in migraine

According to the report of global burden of disease (GBD) 2016, migraine headache has been established as the leading disability cause in the globe among under 50 years old \[1\]. It has been estimated that migraine affects about 11% of adults with a major impact on those aged between 25 to 55 years, which consequently lead to the high headache burden on individuals, communities, health care systems, and societies. Migraine is 2-3 times more common in women than in men. Migraine attacks are usually more prolonged, with higher intensity and more disability among females.

Current pharmacological treatments for migraine demonstrated limited efficacy in some patients and commonly lead to some adverse events such as weight reduction or weight gain, fatigue/sleepiness, sweating, night dreams, gastrointestinal upset and hypotension or reduced concentration. Novel therapeutic approaches of nutritional agents have become the promising strategies to alleviate symptoms of migraine. Vitamin D, one of the dietary agents, has revealed some potential in managing pain and migraine.

Cytomegalovirus (CMV) contamination is one of the clinically most critical irresistible complications of solid-organ transplantation. CMV disease, characterized as a critical rise within the titer of CMV-specific antibodies, happens in 44 % to 85% of kidney, heart, and liver transplant recipients - basically within the to begin with 3 months post transplantation, when immunosuppression is most intense. CMV malady shows in transplant beneficiaries essentially within the organ transplanted with the chance of successive dispersal and disability of other organs such as the central-nervous system, eye, and urogenital- or gastrointestinal tract. Additionally, dynamic CMV disease could be a noteworthy autonomous indicator of intense unite dismissal and event of artful contaminations.

Join brokenness and dismissal are related with vitamin D (VD) lack. In patients with end-stage organ disappointment anticipating transplant, VD lacking and lack are greatly common. Inadequately levels of vitamin D metabolites (25-hydroxyvitamin D \[25(OH)D3\] and 1,25-hydroxyvitamin D \[1a,25_ Dihydroxyvitamin D3\] have been detailed for patients with terminal congestive heart disappointment. pneumonic infection, liver disappointment \[5\], and incessant kidney illness.

in the past few years, there has been increasing interest in the complex interplay between vitamin D and infectious pathogens 7 Vitamin D supplementation is beneficial for patients with HIV, hepatitis C virus, Chlamydia spp. or mycobacterial infection. A significant reduction in the risk of CMV infection and disease by vitamin D supplementation would be highly attractive because of a high therapeutic index of vitamin D, the ease of application (oral solutions), and added benefits such as improved musculoskeletal health. Contrary to expectation, we found that CMV infection interferes with the vitamin D system of mammalian cells.

CMV infection downregulated vitamin D receptor expression and this downregulation was specific for CMV and was not observed for other, common human viruses. This observation may have far-reaching virological, immunological, and clinical implication

The aim of the present study was to assess a possible effect of migraine in patients with CMV infection on vit D levels and Glutamate levels to combine existing knowledge about the role of glutamate in migraine pathogenesis along with information on nutrients that are protective against glutamate excitotoxicity, and then end with a proposed dietary treatment for migraine management.

There is an obvious gap between our understanding of migraines and the dietary strategies which have been administered so far, since dietary nutrients are often studied separately, and no specific diet for migraine has been developed. However, the beneficial effects of the low glutamate diet on widespread chronic pain disorders appear to have overlapping mechanistic effects, and additionally is some preliminary evidence supporting an effect on migraine. Thus, further research on this dietary strategy in migraine is warranted

Eligibility Criteria:
Inclusion Criteria:

1. Selected patients fulfilled the criteria for diagnosis of migraine headache based on International Classification of Headache Disorders-II (ICHD-II) diagnostic criteria.
2. The age of the selected patients ranged between 15 and 55 years of both sexes
3. Able to give informed consent.

Exclusion Criteria:

* b. Exclusion criteria:

  1. presence of neurological disease other than migraine
  2. presence of other chronic medical conditions
  3. Participants in both groups were excluded from the study if they consumed vitamin D supplements in the preceding 3 months (any dose); or if they were taking medications that could affect vitamin D serum level such as glucocorticoids, thiazide diuretics, or statins. 4)patients refuse to participate in the study