Chernenko A. Optimization of diagnostic and treatment approaches to patients with migraine and co-occurring cevicalgia

Understanding the relationship between migraine and comorbid cervical pain is important to ensure optimal treatment strategies, which is made more complex because there are two separate conditions that need to be treated, and the two conditions may be interrelated. The aim is optimization of the differential therapy of patients with migraine and co-occurring neck pain basing on the complex clinical-neurological, neuropsychological, neuro-functional research taking into account biochemical biomarkers of pain. 112 patients were examined (m/f - 28/84, 18 – 58 years): 77 - episodic migraines, 35 - cervicogenic headaches. Methods: VAS, headache diary, MIDAS, HIT-6, Inventories by Spielberger – Khanin, Beck, Vein Questionnaire, MSI and NDI, CGRP in blood plasma by enzyme-linked immunosorbent assay, X-ray, MRI, CT scan of the cervical spine, dopplerography of brain vessels, electroencephalography with spectral analysis. Statistical analysis. Сombination of episodic migraine with co-occurring cervicalgia and cervicogenic headache increases number of days with headaches and number of days per month with taking simple and combined analgesics, worsening of everyday activity, work performance according to scales MIDAS and HIT-6, increased anxiety. While conducting spectral analysis of EEG there were identified true differences in the brain’s functional state of patients with episodic migraine between attacks compared with clinically healthy people. Patients with combination of episodic migraine and cervicogenic headache had higher level of CGRP than patients with isolated migraine. Increase of CGRP level in blood plasma influences the course of episodic migraine, connected with number of days of decreased everyday activity because of migraine headache, with intensity of headache during migraine and NDI in case of comorbid cervicalgia. A threshold value of the plasma level of CGRP at the cut-off point was established, which was 132.4 pg/ml, above which a high risk of severe maladaptation and a significant reduction in daily activity due to migraine was predicted. Complex non-pharmacological treatment of pain syndrome in the neck reduces indicators of NDI and MSI, the frequency of headache attacks in 4 weeks, the number of days with headache in 4 weeks and the number of days with simple and combined analgesics, indicators of situational and personal anxiety, autonomic symptoms decreased. The study clarified the relationship between the level of CGRP in blood plasma and the clinical course of episodic migraine, the frequency and severity of attacks. It was established that the presence of accompanying pain syndromes in the form of cervicalgia affects the increase in the plasma level of CGRP in episodic migraine. Determination of blood plasma CGRP can be a useful additional biomarker for the differential diagnosis of migraine with other forms of primary and secondary headache, which will allow to improve the individualized therapy of an acute attack of headache and the formation of preventive tactics. The prognostic role of the peptide related to the calcitonin gene in the clinical course and development of the chronicity of episodic migraine, taking into account comorbid pathology and the amount of analgesic use, was established.