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Chronic daily headache--one disease or two? Diagnostic role of serum ionized magnesium
A Mauskop1, B T Altura, R Q Cracco
1Department of Neurology, State University of New York, Health Science Center at Brooklyn 11203-2098.
Insights
Chronic daily headache (CDH) can be classified into daily migrainous headaches (DMH) and daily tension-type headaches (DTH). Disturbed magnesium metabolism may serve as a biomarker for differentiating these chronic headache types.
Area of Science:
- Neurology
- Biochemistry
Background:
- Chronic daily headache (CDH) is prevalent but lacks distinct classification.
- Current classifications do not fully encompass the spectrum of daily headache disorders.
Purpose of the Study:
- To differentiate chronic daily headache (CDH) into distinct syndromes.
- To investigate potential biological markers for distinguishing between daily migrainous headaches (DMH) and daily tension-type headaches (DTH).
Main Methods:
- Patients with CDH were clinically divided into groups with and without migrainous features.
- Serum ionized magnesium levels and ionized calcium/magnesium ratios were measured.
- Family history and substance overuse (caffeine, drugs) were assessed.
Main Results:
- A clear distinction was observed between daily migrainous headaches (DMH) and daily tension-type headaches (DTH).
- Patients with DMH showed a higher incidence of disturbed magnesium metabolism, including low serum ionized magnesium and elevated ionized calcium/magnesium ratios, compared to DTH patients.
- Family history of headaches was more common in the DMH group.
Conclusions:
- The clinical differentiation of CDH into DMH and DTH is supported by biochemical findings.
- Disturbed magnesium metabolism may represent a biological marker for diagnosing specific chronic headache syndromes.
- Further research into magnesium's role in headache pathophysiology is warranted.
Abstract:
The entity of chronic daily headache (CDH) is well documented, but is not included in the current classification. We divided patients with CDH into groups with and without migrainous features. This division resulted in clearly distinguishable syndromes of daily migrainous headaches (DMH) and daily tension-type headaches (DTH). Family history of headaches was more common in patients with DMH. Patients in both groups had a high incidence of caffeine or drug overuse. The clinical division into DMH and DTH was supported by our finding of a higher incidence of disturbed magnesium (Mg) metabolism in patients with DMH. Of 26 patients with DMH, 8 (30.8%) had low serum ionized, but not total, Mg levels, and 16 (61.5%) had high ionized calcium/magnesium ratios. The corresponding numbers for the 22 patients with DTH were 1 (4.5%) and 8 (36.4%). These new laboratory measurements offer possible biological markers for the diagnosis of different headache syndromes.