Hematologic Differences Between Migraineurs and Tension-Type Headache Patients.

Background: Headaches are among the most common complaints observed in neurology and medicine, notably migraines and tension-type headaches (TTH). Objective: The purpose of this study was to compare hematologic parameters comprised hemoglobin, hematocrit, platelets, leukocytes, neutrophil-to-lymphocyte ratio (NLR), platelets-to-lymphocyte ratio (PLR) and lymphocyte-to-monocyte ratio (LMR) between migraineurs and tension-type headache patients. Methods: This cross-sectional study included 23 migraineurs and 23 TTH-diagnosed patients, in accordance with the International Classification of Headache Disorders-3 beta version (ICHD-3-beta). The patients underwent hematological laboratory testing, which included assessments of their serum levels of hemoglobin, hematocrit, platelets, leucocytes as well as neutrophils, lymphocytes and monocytes. Results: There were significant differences in the mean platelets serum levels between migraineurs and TTH patients, with migraineurs having 355.3 x 103/µl (SD±47.4 x 103/µl) and TTH patients having 282.0 x 103 /µl (SD± 44.2 x 103) /µl, respectively (p = 0.001). However, there were no differences in the mean level of hemoglobin, hematocrit and leukocytes between the two groups. There was also a significant difference in PLR between migraineurs and TTH patients, with a ratio of 138.1 (SD±36.0) in migraineurs and 110.2 (SD±21.9) in TTH patients (p =0.003), but no differences in NLR or LMR. Conclusion: The mean serum levels of platelets and platelets-to-lymphocyte ratio of migraineurs were significantly higher than TTH patients. However, there were no differences in the mean levels of hemoglobin, hematocrit, leukocytes, NLR and LMR between the two groups.

Effect of Flunarizine on Serum Glutamate Levels and its Correlation with Headache Intensity in Chronic Tension-Type Headache Patients.

BACKGROUND: Some of the excitatory neurotransmitters including glutamate have been suggested to be involved in headache pathophysiology. To our knowledge, there is a lack of publication about flunarizine efficacy in chronic tension-type headache (CTTH) treatments and the roles of glutamate in CTTH pathophysiology. AIM: This study aimed to investigate the flunarizine effect on serum levels of glutamate and its correlation with headache intensity based on the Numeric Rating Scale for pain (NRS) scores in CTTH patients. METHOD: In a prospective randomised, double-blind study with pre and post-test design, seventy-three CTTH patients were randomly allocated with flunarizine 5 mg, flunarizine 10 mg and amitriptyline 12.5 mg groups. The serum levels of glutamate and NRS scores were measured before and after 15-day treatment. RESULTS: Flunarizine 5 mg was more effective than flunarizine 10 mg and amitriptyline 12.5 mg in reducing serum glutamate levels, whereas amitriptyline 12.5 mg was the most effective in reducing headache intensity. There was found nonsignificant, but very weak negative correlation between headache intensity and serum glutamate levels after flunarizine 5 mg administration (r = -0.062; P = 0.385), nonsignificant very weak negative correlation after flunarizine 10 mg administration (r = -0.007; P = 0.488) and there was found a significant moderate positive correlation (r = 0.508; P = 0.007) between headache intensity and serum glutamate levels after amitriptyline 12.5 mg administration. CONCLUSION: Since there was no significant correlation found between serum glutamate and headache intensity after treatment with flunarizine, it is suggested that decreasing of headache intensity after flunarizine treatment occurred not through glutamate pathways in CTTH patients.