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Changes of calcitonin gene-related peptide and other serological indicators in vestibular migraine patients
doi: 10.2478/fzm-2021-0014
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Abstract:
Objective It aims to evaluate the diagnostic ability of CGRP and other blood indicators in vestibular migraine (VM) patients, and to explain the potential pathological effects of these biomarkers. The hypothesis of VM being a variant of migraine was examined. Methods A total of 32 VM patients, 35 migraine patients, and 30 healthy control subjects (HC) were selected for this cross-sectional study. Detailed statistics on demographic data, clinical manifestations, calcitonin gene-related peptide (CGRP) and common clinical laboratory indicators were measured within 24 hours from the onset of the conditions. Receptor operating characteristic (ROC) curve and area under the curve (AUC) were analyzed for biomarkers. The risk factors of VM and migraine were determined through univariate and multivariate analyses. Results Compared with HC, serum CGRP levels (p(VM) = 0.012, p(Migraine) = 0.028) increased and Mg2+ levels (p(VM) < 0.001, p (Migraine) < 0.001) deceased in VM patients and migraine patients. In multiple logistic regression, VM was correlated with CGRP [odds ratio (OR) = 1.07; 95% confidence interval (CI), 1.02-1.12; P = 0.01] and Mg2+ [odds ratio (OR) = 0.03; 95% CI, 0.07-0.15; P < 0.001)]. Migraine was correlated with CGRP [odds ratio (OR) = 1.07; 95% CI, 1.02-1.12; P = 0.01] and Mg2+ [odd ratio (OR = 0.01; 95% CI, 0-0.02; P < 0.001)]. Mg2+ discriminated good differentiation between VM and migraine groups, with AUC of 0.649 (95% CI, 0.518 to 0.780). The optimal threshold for Mg2+ to diagnose VM was 0.805. Conclusions This study demonstrated that CGRP and Mg2+ may be promising laboratory indicators to discriminate HC from VM/migraine, while Mg2+ may be uded as a discriminator between VM and migraine. -
Figure 1. The CGRP and Mg2+ levels in vestibular migraine patients, migraine patients and healthy controls
The error bars indicate standard deviation. *, p < 0.05.
Abbreviation: CGRP, calcitonin gene related peptide; Mg2+, Magnesium ions.
Figure 2. ROC curve by using CGRP and Mg2+ indicators to classify vestibular migraine patients, migraine patients and healthy controls
Abbreviation: AUC, area under curve; ROC, receiver operating characteristic curve; CGRP, calcitonin gene related peptide; Mg2+, Magnesium ions.
Table 1. Demographical, physiological, and clinical characteristics of vestibular migraine (VM) patients, migraine patients and control healthy (n = 97)
Variables HC (N = 30) Migraine (N = 35) VM (N = 32) ANOVA P Demographic characteristics Gender (Male/Female) 14/16 14/21 12/20 0.703d Age (years) 49.90±7.25 47.86±9.00 52.52±8.06 0.068 Risk factors Smoking(percentage) 2(6.67) 3(8.57) 5(15.162) 0.498 Drinking(percentage) 2(6.67) 3(8.57) 4(12.5) 0.746 Systolic blood pressure (mmHg) 127.93±10.68 126.43±15.89 134.15±19.68 0.118 Diastolic blood pressure (mmHg) 79.57±7.60 78.54±13.79 80.05±10.97 0.732 Laboratory test indicators CGRP (pg/mL) 62.41±11.46 70.82±10.90b 70.45±12.27c 0.007* Mg2+(mmol/L) 0.88±0.06 0.81±0.07b 0.76±0.07ac < 0.001* Red blood cell (1012/L) 4.68±0.49 4.71±0.51 4.72±0.52 0.444 Platelet (109/L) 230.44±70.21 253.94±54.79 254.36±52.42 0.210 Blood glucose (mmol/L) 5.73±0.46 5.69±1.21 5.31±1.35 0.264 Cholesterol (mmol/L) 5.10±0.95 4.96±1.06 5.22±0.73 0.521 Triglyceride (mmol/L) 1.85±1.40 1.91±1.50 1.76±1.28 0.817 Data are expressed as mean±SD. Abbreviations: CGRP, Calcitonin gene-related peptide; Mg2+, Magnesium ions. Data were analyzed by one-way ANOVA and Tukey's post hoc test.a, P < 0.05 VM vs. control; b P < 0.05 migraine patients vs. control; c, P < 0.05 VM vs. migraine patients; d, Chi-square test; *, ANOVA P < 0.05. 
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Table 2. Summary of clinical characteristics of the VM and migraine patients included in the present study
Variables Migraine (N = 35) VM (N = 32) P value Symptoms Frequency (number of times) 2.14±1.14 1.34±0.86 0.002* Duration(hours) 15.59±17.40 8.30±11.57 0.050* Accompanying symptoms Nausea 22(62.86) 24(75) 0.285b Vomiting 14(40) 18(56.25) 0.183b Tinnitus 0(0) 5(15.63) 0.015b* Blurred vision 7(20) 3(9.4) 0.223b Defecation 0(0) 1(3.1) 0.292b Comorbidities Arterial hypertension 8(22.86) 14(43.75) 0.069b Depression 4(11.43) 2(6.25) 0.458b Data are expressed as mean±SD. Values are shown as number (percentage) except where specified. *P < 0.05; a two sample t-test; b Chi-squared test.
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Table 3. Univariate and multivariate logistic regression analyses between VM patients and migraine patients
Variables VM Migraine Univariate Multivariate Univariate Multivariate OR (95% CIs) P value OR (95% CIs) P value OR (95% CIs) P value OR (95% CIs) P value Age 1.06
(1.01-1.12)0.03* 1.04
(0.98-1.11)1.04 0.95
(0.90-1.00)0.06 0.97
(0.91-1.03)0.35 Gender 1.216
(0.51-2.91)0.66 1.52
(0.54-4.08)1.52 1.04
(0.45-2.43)0.93 1.30
(0.48-3.55)0.61 Current smoking 0
(0-)0.99 1.012
(0.26-2.66)0.11 5.63
(0.56-56.3)0.14 2.53
(0.25-25.77)0.43 Current drinking 0.48
(0.05-4.52)0.52 0.84
(0.44-17.42)0.43 2.77
(0.05-25.77)0.28 2.53
(0.25-25.77)0.44 Frequency
(number of times)1.43
(1.24-1.78)0.01* - 2.31
(1.29-4.16)0.01* - Duration
(hours)0.96
(0.92-1.00)0.07 - 1.04
(1.00-1.09)0.07 - Nausea 1.57
(0.54-4.53)0.41 - 0.64
(0.22-1.85)0.41 - Vomiting 1.93
(0.73-5.10)0.19 - 0.52
(0.20-1.37)0.19 - Tinnitus 1.12
(0.32-3.89)0.86 - 0.90
(0.36-3.13)0.86 - Defecation 2.27
(0.20-26.27)0.51 - 0.44
(0.34-5.11)0.51 - CGRP 1.01
(0.98-1.05)0.46 1.07
(1.02-1.12)0.01* 1.03
(0.99-1.07)0.11 1.07
(1.02-1.12)0.01* Mg2+ 0
(0-0.002)< 0.001* 0.03
(0.07-0.15)< 0.001* 0.15
(0-21.76)0.45 0.01
0(0-0.02)< 0.001* Note: CI, confidence interval; OR, odds ratio. CGRP, calcitonin gene-related peptide; Mg2+, Magnesium ions. *, P < 0.01.
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Table 4. ROC analysis results (AUC and Youden indices) for VM patients, migraine patients and control subjects
Variables AUC value p value 95% CI Youden index Optimal threshold CGRP Migraine vs. HC 0.694 0.009* (0.563, 0.825) 0.364 55.655 ng/ml VM vs. HC 0.680 0.016* (0.545, 0.815) 0.357 54.15 ng/ml Migraine vs. VM 0.531 0.663 (0.391-0.670) 0.132 59.365 ng/ml Mg2+ Migraine vs. HC 0.812 < 0.001* (0.706-0.919) 0.55 0.885 mmol/l VM vs. HC 0.907 < 0.001* (0.837, 0.978) 0.687 0.805 mmol/l Migraine vs. VM 0.649 0.035* (0.518, 0.780) 0.244 0.805 mmol/l Abbreviations: CGRP, Calcitonin gene-related peptide; Mg2+, Magnesium ions; AUC, Area Under Curve; CI, Confidence interval.
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