Research Submissions: Cerebrospinal Fluid Sodium Increases in Migraine

• Published in: Headache Vol. 46; no. 7; pp. 1128 - 1135
• Main Authors: Harrington, Michael G, Fonteh, Alfred N, Cowan, Robert P, Perrine, Kathy, Pogoda, Janice M, Biringer, Roger G, Huehmer, Andreas FR
• Format: Journal Article
• Language: English
• Published: 01.07.2006
• ISSN: 0017-8748; 1526-4610
• DOI: 10.1111/j.1526-4610.2006.00445.x

Background.-Pharmaceuticals with calcium- or sodium-channel-blocking activity have proven useful for migraine prophylaxis, and calcium channel, sodium transporter, and sodium channel gene mutations have been found in familial hemiplegic migraine. However, it is not known whether calcium or sodium homeostasis is altered in migraine. Objective.-To compare levels of sodium, calcium, potassium, and magnesium in cerebrospinal fluid (CSF) and blood plasma between migraineurs and controls. Methods.-We recruited 20 migraineurs without aura and 11 controls prospectively, and studied migraineurs in sick (MH super(+)) and well (MH super(-)) states. We collected lumbar CSF and venous blood plasma, quantified elements with ion-selective electrodes or colorimetry, and determined osmolality by depression of freezing point. We compared levels of Na super(+), Ca super(2+), K super(+), and Mg among and also within subjects who were studied in both MH super(+) and MH super(-) states. Results.-Mean CSF Na super(+) levels were increased by 3 mmol-L in MH super(+) compared with MH super(-) and by 4 mmol-L compared to controls (P < 0.005). In 4 subjects who were sampled in both MH super(+) and MH super(-) states, mean CSF Na super(+) concentration increased by 2 mmol-L in the MH super(+) state compared with the MH super(-) state (P < 0.05). Simultaneous plasma Na super(+) levels did not differ among the 3 clinical groups, nor did osmolality, total Ca and Ca super(2+), K super(+), and total Mg levels in CSF. Conclusions.-Compared to both controls and the MH super(-) state, CSF Na super(+) concentration increased in MH super(+) independently from other clinical or pharmacological fluctuations, CSF concentrations of Ca super(2+), Mg, and K super(+), and blood plasma Na super(+) levels. These results implicate a deviation of Na super(+) homeostasis in migraine. The modestly elevated extracellular Na super(+) in MH super(+) may cause the neural changes that underlie clinical features of migraine.