Possible Biomarker for Migraine

Blood levels of a group of bioactive lipids may be useful as a marker for episodic migraine, according to a new study.

Sphingolipids are critical components of cell membranes and play a role in regulating energy homeostasis, apoptosis, and inflammation. Recent studies suggest that subtle changes of sphingolipid balance may be involved in dementia and multiple sclerosis, and sphingolipid metabolism has been implicated in neurologic disorders such as Gaucher disease, note the authors, led by B. Lee Peterlin, DO, from Johns Hopkins University School of Medicine, Baltimore, MD.

For the study, 52 women with episodic migraine and 36 women who did not have any headaches underwent a neurologic exam, had their body mass index measured, and provided blood samples. Women with migraine had an average of 5.6 headache days per month. Episodic migraine is defined as having less than 15 headaches per month.

Total blood levels of the sphingolipid ceramides were decreased in women with episodic migraine as compared to those women without any headache disorders. Women with migraine had approximately 6,000 ng per ml of total ceramides in their blood compared to 10,500 ng per ml in women without headache. Every standard deviation increase in total ceramide levels was associated with more than a 92% lower risk of having migraine.

In addition, 2 other types of lipids, called sphingomyelin, were associated with a 2.5 times greater risk of migraine with every standard deviation increase in their levels.

The researchers also tested the blood of a random, small sample of 14 participants for a panel of these lipids. They were able to correctly identify those who had migraine or who were controls without headache based on sphingolipid blood levels. "While this finding should be cautiously interpreted given the small sample size, it suggests that sphingolipid panels may have the potential to be utilized as a migraine diagnostic tool," they stated.

In conclusion, the researchers stated: "Taken together, our findings suggest it is possible that migraine is a neurologic disorder of 'minor' sphingolipid dysmetabolism. Further research, validating the ceramide and sphingomyelin associations with migraine, as well as research examining mechanisms for these associations, may advance our understanding of migraine pathophysiology and open possibilities of the identification of novel migraine biomarkers and targeted drug therapies directed against sphingolipid pathways."

In a comment on the study, Karl Ekbom, MD, PhD, with the Karolinska Institutet in Stockholm, Sweden, wrote: “A biological marker for migraine would be of great value in clinical practice.” He added: “This study is a very important contribution to our understanding of the underpinnings of migraine and may have wide-ranging effects in diagnosing and treating migraine if the results are replicated in further studies.”

Ekbom noted several limitations of the study: it included only women, did not study chronic migraine, and included an unusually high percentage of participants who had migraine with aura.

He also cautioned that “before claiming that altered sphingolipid metabolism might provide a diagnostic tool for migraine, a comparison should be made with other types of headache, for example, cluster headache.”