Abstract
BackgroundA recent study showed that 60–s paranasal air suction results in an immediate pain relief in acute migraine. This is the study to assess the Nitric Oxide (NO) and Carbon Monoxide (CO) concentration in nasal-paranasal sinus air of migraine patients and to compare it with healthy controls.MethodologyThe NO and CO levels of air sucked out from nasal-paranasal sinuses of 20 migraine adolescent and young adults among school students, aged 16 –19 years, and 22 healthy similar aged school students as controls were measured as key responses using a portable NO and a portable CO analyzer.ResultsPatients had comparatively high values compared to the controls for paranasal NO (both left and right sides), paranasal CO (both left and right sides), Fraction Exhaled NO (FeNO) and Fraction Exhaled CO (FeCO). Patients had median paranasal NO contents of 132.5 ppb and 154 ppb on left and right sides respectively compared to 36 ppb and 34.5 ppb corresponding values in controls (P < 0.0001). Similar pattern was observed with paranasal CO (P < 0.0001). FeNO and FeCO content were also higher in patients (P < 0.0001). Receiver characteristic operating curves of all gas measurements showed that they all could classify patients and controls effectively and NO was the most effective followed by paranasal CO. After air suction, the mean pain scores of general headache and tenderness dropped by a very large margin in migraine patients (P < 0.0001).ConclusionsSuctioned out high nasal-paranasal sinus NO and CO levels can be used to distinguish migraine patients from healthy subjects. In fact, suctioned out paranasal NO measurements of both sides with a cutoff point of 50 ppb provided a perfect classification of patients and controls. Increased sinus NO and CO during acute episode of migraine is an observation we had and we agree that further studies are needed to conclude that NO and CO can be a causative molecule for migraine headache.Trail registrationClinical Trial Government Identification Number – 1548/2016.Ethical Clearance Granted Institute – Medical Research Institute, Colombo, Sri Lanka (No 38/2016).Sri Lanka Clinical Trial Registration number: SLCTR/ 2017/018 (29/06/2017).Approval Granting Organization to use the device in the clinical trial– National Medicines Regulatory Authority Sri Lanka (16/06/2018), The device won award at Geneva international inventers exhibition in 2016 and President award in 2018 in Sri Lanka. It is a patented device in Sri Lanka and patent number was SLKP/1/18295.All methods were carried out in accordance with CONSORT 2010 guidelines.
Highlights
Migraine is a primary headache disorder that occurs at all ages and is characterized by recurring, moderate to severe headache that usually lasts from 4 h to 3 days with accompanying nausea, vomiting and sensitivity to light or sound
Paranasal median Nitric Oxide (NO) levels of left and right sides in the patient group were 132.5 ppb and 154 ppb respectively compared to corresponding values of 32 ppb and 34.5 ppb respectively in the control group
The difference between patients and the controls for paranasal NO and Carbon Monoxide (CO) was in line with difference between patients and the controls for exhaled NO and exhaled CO
Summary
Migraine is a primary headache disorder that occurs at all ages and is characterized by recurring, moderate to severe headache that usually lasts from 4 h to 3 days with accompanying nausea, vomiting and sensitivity to light or sound. In this research NO and CO levels of the air sucked out from nasal-paranasal sinus were studied in migraine patients and normal healthy subjects as an indirect level of NO and CO in para nasal sinuses and were compared. This is the first case control study to assess the NO and CO concentration in paranasal sinus air of migraine patients. A recent study showed that 60–s paranasal air suction results in an immediate pain relief in acute migraine This is the study to assess the Nitric Oxide (NO) and Carbon Monoxide (CO) concentration in nasal-paranasal sinus air of migraine patients and to compare it with healthy controls
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