The relationship between migraine severity and trace elements/heavy metals levels

ABSTRACT OBJECTIVE and HYPOTHESIS: Due to its high prevalence, significant disability, and high number of emergency admissions, migraine is a major health problem. Despite numerous studies, its pathophysiology remains unclear. Disability related to migraine is an indicator of disease severity. The Migraine Disability Assessment (MIDAS) is a validated method used for this purpose. It is known that trace element and heavy metal (TEHM) levels are associated with headaches. However, the role of TEHM levels in migraine pathophysiology has not been clearly elucidated. In our study, we aimed to determine the TEHM levels in patients with acute migraine attacks and to demonstrate their relationship with parameters related to migraine severity, particularly MIDAS. METHODS: The study was conducted with 120 participants, including 60 patients presenting to the Emergency Department of Yozgat Bozok University with acute migraine attacks and 60 healthy controls. The blood levels of 7 heavy metals (arsenic, cadmium, cobalt, lead, mercury, nickel, tin) and 8 trace elements (antimony, chromium, copper, iron, magnesium, manganese, molybdenum, zinc) were measured using inductively coupled plasma mass spectrometry and compared between the groups. A p value <0.05 was considered statistically significant. RESULTS: The median age of all participants was 27 (22-40) years. The gender distribution (male/female) was 30/70. There were no significant differences between the patient and control groups in terms of age, gender, smoking status, and body mass index (p = 0.877, 1.0, 0.852, and 0.428, respectively). While no significant differences were found between genders in terms of attack duration, Visual Analog Scale (VAS) score, and number of attacks in the last three months (p = 0.385, 0.876, and 0.389, respectively), females had higher MIDAS scores (p = 0.038). However, there was no gender effect on MIDAS grades (p = 0.139). The MIDAS score was correlated with gender and number of attacks in the last three months in patients (p = 0.04 and 0.004, respectively). A statistically significant relationship was found between MIDAS grades and attack frequency (p = 0.003). No significant correlation was found between age, body mass index, smoking status, education level, VAS score, attack duration, presence of aura, age at diagnosis, disease duration, and MIDAS score (p = 0.19, 0.26, 0.44, 0.58, 0.52, 0.98, 0.88, 0.25, and 0.39, respectively). In the patient group, the levels of arsenic, cobalt, lead, nickel, tin, antimony, chromium, copper, iron, magnesium, manganese, and zinc were found to be increased (p <0.001, 0.026, 0.038, 0.182, 0.003, 0.003, <0.001, 0.011, 0.027, 0.001, <0.001, and <0.001, respectively), molybdenum levels were decreased (p <0.001), and cadmium levels remained unchanged (p = 0.535). No significant relationship was found between MIDAS score and grades and levels of arsenic, cadmium, cobalt, lead, nickel, tin, antimony, chromium, copper, iron, magnesium, manganese, molybdenum, and zinc (p = 0.70, 0.35, 0.48, 0.26, 0.54, 0.94, 0.21, 0.90, 0.93, 0.25, 0.30, 0.63, 0.27, and 0.54, respectively). Only tin showed a statistically significant negative correlation with MIDAS grades in the aura migraine group (p = 0.03). No significant relationship was found between MIDAS score and grades and aura migraine group. CONCLUSION: Our study is the first to explain the relationship between TEHM levels and disability. Although TEHM levels differed in migraine patients, these changes were not found to be associated with migraine severity. However, due to the inadequate generalizability of our current results, larger and multicenter studies are needed. Keywords: migraine, migraine severity, trace element, heavy metal, MIDAS