THE VALUE OF THE SYSTEMIC IMMUNE INFLAMMATION INDEX (SII) IN MIGRAINE PATIENTS TREATED WITH GREATER OCCIPITAL BLOCK TREATMENT

Sevil Sadri; Gözde Ülfer; Burcu Polat

doi:10.5937/sanamed0-44601

Sevil Sadri Ministry of Health Bursa City Hospital, School of Medicine, Internal Medicine Department of Hematology, Bursa, Turkey
Gozde Ulfer Istanbul Medipol University, School of Medicine, Department of Biocehmistry, Istanbul, Turkey
Burcu Polat Duzce University, Department of Neurology, Düzce, Turkey

DOI: https://doi.org/10.5937/sanamed0-44601

Keywords: migraine, neuroinflammation, systemic immune inflammation index

Abstract

Introduction: Neuroinflammation plays a key role in various neurological conditions, including migraine. GON block has been used for both acute and preventive treatment in migraine sufferers. Exploring whether this localized nerve blocking therapy for migraines affects signs of systemic inflammation would be beneficial.

Materials and Methods: In this study, a total of 50 migraineurs (comprising high-frequency episodic and chronic migraine) and 60 healthy control volunteers of comparable ages and sexes were enrolled. The neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and SII levels in migraine patients, migraine sufferers, and healthy individuals are compared. This study examined hematological parameters and SII levels used as inflammatory markers in those diagnosed with migraine.

Results: It was determined that the mean platelet and PLR values of the case group's subjects were substantially lower than those of the patient group's subjects (p < 0.05). Biochemical characteristics of the cases were examined before and after treatment with greater occipital nerve (GON) block, revealing a statistically significant reduction in attack frequency, severity, and duration (p < 0.001). No significant differences were discovered when compared to post-treatment values (p > 0.05), even though the ratios were greater prior to GON block therapy in other measures.

Conclusion: These findings, in our opinion, are linked to the presence of a continuous inflammatory process even in the absence of episodes, supporting systemic inflammation in migraineurs. Thus, SII, an affordable and easily measurable marker in peripheral blood, may serve as a helpful predictive marker for migraine patients scheduled for GON block treatment. Further extensive research is needed to determine whether SII can be an independent prognostic factor in migraine patients.

References

1. Kursun O, Yemisci M, van den Maagdenberg AMJM, Karatas H. Migraine and neuroinflammation: the inflammasome perspective. J Headache Pain. 2021;22(1):55. doi: 10.1186/s10194-021-01271-1.

2. Perry CJ, Blake P, Buettner C, Papavassiliou E, Schain AJ, Bhasin MK, et al. Upregulation of inflammatory gene transcripts in periosteum of chronic migraineurs: Implications for extracranial origin of headache. Ann Neurol. 2016;79(6):1000-13. doi: 10.1002/ana.24665.

3. Rudiger A, Burckhardt OA, Harpes P, Müller SA, Follath F. The relative lymphocyte count on hospital admission is a risk factor for long-term mortality in patients with acute heart failure. Am J Emerg Med. 2006;24(4):451-4. doi: 10.1016/j.ajem.2005.10.010.

4. Holland S, Silberstein SD, Freitag F, Dodick DW, Argoff C, Ashman E; Quality Standards Subcommittee of the American Academy of Neurology and the American Headache Society. Evidence-based guideline update: NSAIDs and other complementary treatments for episodic migraine prevention in adults: report of the Quality Standards Subcommittee of the American Academy of Neurology and the American Headache Society. Neurology. 2012;78(17):1346-53. doi: 10.1212/WNL.0b013e3182535d0c.

5. Reed KL, Black SB, Banta CJ 2nd, Will KR. Combined occipital and supraorbital neurostimulation for the treatment of chronic migraine headaches: initial experience. Cephalalgia. 2010;30(3):260-71. doi: 10.1111/j.1468-2982.2009.01996.x.

6. Ashkenazi A, Levin M. Greater occipital nerve block for migraine and other headaches: is it useful? Curr Pain Headache Rep. 2007;11(3):231-5. doi: 10.1007/s11916-007-0195-3.

7. Afridi SK, Shields KG, Bhola R, Goadsby PJ. Greater occipital nerve injection in primary headache syndromes--prolonged effects from a single injection. Pain. 2006;122(1-2):126-9. doi: 10.1016/j.pain.2006.01.016.

8. Kemper RH, Meijler WJ, Korf J, Ter Horst GJ. Migraine and function of the immune system: a meta-analysis of clinical literature published between 1966 and 1999. Cephalalgia. 2001;21(5):549-57. doi: 10.1046/j.1468-2982.2001.00196.x.

9. Lénárt N, Brough D, Dénes Á. Inflammasomes link vascular disease with neuroinflammation and brain disorders. J Cereb Blood Flow Metab. 2016;36(10):1668-85. doi: 10.1177/0271678X16662043.

10. Yazar HO, Yazar T, Aygün A, Kaygisiz Ş, Kirbaş D. Evaluation of simple inflammatory blood parameters in patients with migraine. Ir J Med Sci. 2020;189(2):677-83. doi: 10.1007/s11845-019-02136-y.

11. Eryigit U, Altunayoglu Cakmak V, Sahin A, Tatli O, Pasli S, Gazioglu G, et al. The diagnostic value of the neutrophil-lymphocyte ratio in distinguishing between subarachnoid hemorrhage and migraine. Am J Emerg Med. 2017;35(9):1276-80. doi: 10.1016/j.ajem.2017.03.063.

12. Poyrazoğlu HG, Öztürk AB. Predictive value of laboratory parameters in childhood migraine. Acta Neurol Belg. 2020;120(4):907-14. doi: 10.1007/s13760-019-01106-6.

13. Karabulut KU, Egercioglu TU, Uyar M, Ucar Y. The change of neutrophils/lymphocytes ratio in migraine attacks: A case-controlled study. Ann Med Surg (Lond). 2016;10:52-6. doi: 10.1016/j.amsu.2016.07.023.

14. Hu B, Yang XR, Xu Y, Sun YF, Sun C, Guo W, et al. Systemic immune-inflammation index predicts prognosis of patients after curative resection for hepatocellular carcinoma. Clin Cancer Res. 2014;20(23):6212-22. doi: 10.1158/1078-0432.CCR-14-0442.

15. Yang R, Chang Q, Meng X, Gao N, Wang W. Prognostic value of Systemic immune-inflammation index in cancer: A meta-analysis. J Cancer. 2018;9(18):3295-302. doi: 10.7150/jca.25691.

16. Zhong JH, Huang DH, Chen ZY. Prognostic role of systemic immune-inflammation index in solid tumors: a systematic review and meta-analysis. Oncotarget. 2017;8(43):75381-8. doi: 10.18632/oncotarget.18856.

17. Zeller JA, Lindner V, Frahm K, Baron R, Deuschl G. Platelet activation and platelet-leucocyte interaction in patients with migraine. Subtype differences and influence of triptans. Cephalalgia. 2005;25(7):536-41. doi: 10.1111/j.1468-2982.2005.00916.x.

18. Freedman JE, Loscalzo J. Platelet-monocyte aggregates: bridging thrombosis and inflammation. Circulation. 2002;105(18):2130-2. doi: 10.1161/01.cir.0000017140.26466.f5.

19. Gasparyan AY, Ayvazyan L, Mikhailidis DP, Kitas GD. Mean platelet volume: a link between thrombosis and inflammation? Curr Pharm Des. 2011;17(1):47-58. doi: 10.2174/138161211795049804.

20. Celikbilek A, Zararsiz G, Atalay T, Tanik N. Red cell distribution width in migraine. Int J Lab Hematol. 2013;35(6):620-8. doi: 10.1111/ijlh.12100.

21. Bas FY, Demirci S, Arslan B .The relationship between headache features and haematological parameters in migraine patients. Euras J Fam Med. 2015;4(2):53–6.

22.. Peatfield RC, Gawel MJ, Guthrie DL, Pearson TC, Glover V, Littlewood J, et al. Platelet size: no correlation with migraine or monoamine oxidase activity. J Neurol Neurosurg Psychiatry,1982;45(9):826–9.

23. Auezova R, Ryskeldiev N, Doskaliyev A, Kuanyshev Y, Zhetpisbaev B, Aldiyarova N et al. Association of preoperative levels of selected blood inflammatory markers with prognosis in gliomas. Onco Targets Ther. 2016;9:6111-7. doi: 10.2147/OTT.S113606.

24. Köklü E, Yüksel İÖ, Arslan Ş, Bayar N, Çağırcı G, Gencer ES, et al. Is Elevated Neutrophil-to-Lymphocyte Ratio a Predictor of stroke in patients with intermediate carotid artery stenosis? J Stroke Cerebrovasc Dis. 2016;25(3):578-84. doi: 10.1016/j.jstrokecerebrovasdis.2015.10.031.

25. Sarıcam G. Relationship between migraine headache and hematological parameters. Acta Neurol Belg. 2021;121(4):899-905. doi: 10.1007/s13760-020-01362-x.

26. Inan LE, Inan N, Karadaş Ö, Gül HL, Erdemoğlu AK, Türkel Y, et al. Greater occipital nerve blockade for the treatment of chronic migraine: a randomized, multicenter, double-blind, and placebo-controlled study. Acta Neurol Scand. 2015;132(4):270-7. doi: 10.1111/ane.12393.

27. Weibelt S, Andress-Rothrock D, King W, Rothrock J. Suboccipital nerve blocks for suppression of chronic migraine: safety, efficacy, and predictors of outcome. Headache. 2010;50(6):1041-4. doi: 10.1111/j.1526-4610.2010.01687.x.

28. Palamar D, Uluduz D, Saip S, Erden G, Unalan H, Akarirmak U. Ultrasound-guided greater occipital nerve block: an efficient technique in chronic refractory migraine without aura? Pain Physician. 2015;18(2):153-62.

29. Aziz MH, Sideras K, Aziz NA, Mauff K, Haen R, Roos D, et al. The Systemic-immune-inflammation Index independently predicts survival and recurrence in resectable pancreatic cancer and its prognostic value depends on bilirubin levels: a retrospective multicenter cohort study. Ann Surg. 2019;270(1):139-146. doi: 10.1097/SLA.0000000000002660

30. Jomrich G, Paireder M, Kristo I, Baierl A, Ilhan-Mutlu A, Preusser M, et al. High Systemic Immune-Inflammation Index is an adverse prognostic factor for patients with gastroesophageal adenocarcinoma. Ann Surg. 2021;273(3):532-41. doi: 10.1097/SLA.0000000000003370.

31. Yang YL, Wu CH, Hsu PF, Chen SC, Huang SS, Chan WL, et al. Systemic immune-inflammation index (SII) predicted clinical outcome in patients with coronary artery disease. Eur J Clin Invest. 2020;50(5):e13230. doi: 10.1111/eci.13230.