Utilizing biomarkers for rapid assessment of headache in the emergency department
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Abstract
INTRODUCTION: Headache is a common presenting complaint in emergency departments (EDs), accounting for 2–5% of admissions. Although most headaches are benign, 4–5% are associated with life-threatening secondary pathologies. Accurate and rapid diagnosis is crucial, yet a standardized protocol for imaging and laboratory assessments is lacking. This study evaluates hematologic parameters as diagnostic tools for predicting acute pathologies in patients presenting with headaches.
MATERIAL AND METHODS: This retrospective study included 199 headache patients and 191 controls, aged 18 and above, who presented to the Ankara Etlik City Hospital between October 1 and December 15, 2022. Hematologic parameters, including neutrophil-to-lymphocyte ratio (NLR), neutrophil-to-platelet ratio (NPR), platelet-to-lymphocyte ratio (PLR), and systemic immune-inflammation index (SII), were analyzed, and compared with non-contrast brain computed tomography findings in patients with severe headaches.
RESULTS: NLR and NPR were significantly elevated in patients with acute pathologies on brain imaging. While platelet levels did not differ, indices like PLR and SII were elevated, indicating their diagnostic potential. Female patients were more prevalent; however, severe headaches and intracranial pathologies were more common in older male patients.
CONCLUSIONS: Hematologic parameters such as NLR, NPR, and SII serve as cost-effective, accessible biomarkers for stratifying headache patients in the ED. These markers can guide decisions on further imaging, particularly in high-risk populations. Future multicenter studies should validate these findings and explore their integration into clinical decision-making algorithms.
Keywords: headache diagnosisbiomarkersemergency departmenthematologic parameters
References
- Patel S, Parikh A, Okorie ON. Subarachnoid hemorrhage in the emergency department. Int J Emerg Med. 2021; 14(1): 31.
- Luciani M, Negro A, Spuntarelli V, et al. Evaluating and managing severe headache in the emergency department. Expert Rev Neurother. 2021; 21(3): 277–285.
- Giamberardino MA, Affaitati G, Costantini R, et al. Acute headache management in emergency department. A narrative review. Intern Emerg Med. 2020; 15(1): 109–117.
- Friedman BW, Grosberg BM. Diagnosis and management of the primary headache disorders in the emergency department setting. Emerg Med Clin North Am. 2009; 27(1): 71–87, viii.
- Filler L, Akhter M, Nimlos P. Evaluation and management of the emergency department headache. Semin Neurol. 2019; 39(1): 20–26.
- Do TP, la Cour Karottki NF, Ashina M. Updates in the diagnostic approach of headache. Curr Pain Headache Rep. 2021; 25(12): 80.
- Ferreira KS, Dhillon H, Velly AM. The role of a potential biomarker in patients with migraine: review and new insights. Expert Rev Neurother. 2021; 21(7): 817–831.
- Ashina M, Terwindt GM, Al-Karagholi MAM, et al. Migraine: disease characterisation, biomarkers, and precision medicine. Lancet. 2021; 397(10283): 1496–1504.
- Sarıcam G. Relationship between migraine headache and hematological parameters. Acta Neurol Belg. 2021; 121(4): 899–905.
- Karabulut KU, Egercioglu TU, Uyar M, et al. The change of neutrophils/lymphocytes ratio in migraine attacks: a case-controlled study. Ann Med Surg (Lond). 2016; 10: 52–56.
- Yazar HO, Yazar T, Aygün A, et al. Evaluation of simple inflammatory blood parameters in patients with migraine. Ir J Med Sci. 2020; 189(2): 677–683.
- Evrin T, Katipoglu B. Evaluation of hematological parameters in migraine attack in emergency room. Anna Med Res. 2019; 26(7): 1384–1387.
- Eryigit U, Altunayoglu Cakmak V, Sahin A, et al. The diagnostic value of the neutrophil-lymphocyte ratio in distinguishing between subarachnoid hemorrhage and migraine. Am J Emerg Med. 2017; 35(9): 1276–1280.
- de Oliveira AJM, Solla DJF, de Oliveira KF, et al. Postoperative neutrophil-to-lymphocyte ratio variation is associated with chronic subdural hematoma recurrence. Neurol Sci. 2022; 43(1): 427–434.
- Sun R, Huang F, Wu W, et al. Association of neutrophil to lymphocyte ratio and D-dimer with functional outcome in patients with cerebral venous sinus thrombosis. BMC Neurol. 2023; 23(1): 30.
- Pruc M, Kubica J, Banach M, et al. Diagnostic and prognostic performance of the neutrophil-to-lymphocyte ratio in acute coronary syndromes: a meta-analysis of 90 studies including 45 990 patients. Kardiol Pol. 2024; 82(3): 276–284.
- Danese E, Montagnana M, Lippi G. Platelets and migraine. Thromb Res. 2014; 134(1): 17–22.
- Li Y, Wen D, Cui W, et al. The prognostic value of the acute phase systemic immune-inflammation index in patients with intracerebral hemorrhage. Front Neurol. 2021; 12: 628557.
- Sadri S, Ülfer G, Polat B. The value of the systemic immune inflammation index (SII) in migraine patients treated with greater occipital block treatment. Sanamed. 2023; 18(2): 119–126.
- Malone CD, Bhowmick A, Wachholtz AB. Migraine: treatments, comorbidities, and quality of life, in the USA. J Pain Res. 2015; 8: 537–547.
- Delaruelle Z, Ivanova TA, Khan S, et al. Male and female sex hormones in primary headaches. J Headache Pain. 2018; 19(1): 117.
- Marcus DA. Gender differences in treatment-seeking chronic headache sufferers. Headache. 2001; 41(7): 698–703.
- Lindbohm JV, Kaprio J, Jousilahti P, et al. Sex, smoking, and risk for subarachnoid hemorrhage. Stroke. 2016; 47(8): 1975–1981.