Perbedaan Parameter Hematologi, Penanda Inflamasi, Kadar Vitamin D dan Magnesium Serum pada Pasien Migren dan Tension Type Headache

Abstract

Background Headaches are very common condition, especially migraines and tension-type headaches (TTH). The pathophysiological mechanisms underlying this disease are still being debated. One of the proposed theories relates to inflammation and nutrition. Inflammation occurs in both migraine and TTH. Micronutrients such as vitamin D and magnesium also play a role in the pathophysiology of migraine and TTH Objective The aim of this study was to determine the differences in hematological parameters, inflammatory markers, vitamin D, and magnesium levels in migraineurs and TTH. Method This study used a cross-sectional design. The subjects who participated in the study were 23 migraine patients and 23 TTH patients. The patients undergo hematological laboratory examination including hematological parameters (hemoglobin, hematocrit, leucocyte, and platelet), inflammatory markers (C reactive protein, Neutrophil lymphocyte ratio, Platelet lymphocyte ratio, Lymphocyte monocyte ratio, and Ddimer), vitamin D and magnesium serum levels. Result There were differences in mean platelet levels between migraineurs and TTH patients with 355.3 x 103/μl (SD = 47.4 x 103/μl) in migraineurs and 282.0 x 103/μl (SD = 44.2 x 103/μl) in TTH patients (p = 0.001) but there were no differences in the mean level of hemoglobin, hematocrit, and leucocyte between two groups. There was difference in term of CRP level with 4.8 mg/l (SD = 3.7 mg/l) in migraineurs and 2.1 mg/l (SD = 1.8 mg/l) in TTH patients (p = 0.003). There was also a difference in Platelet lymphocyte ratio in migraineurs and TTH patients with 138.1 (SD = 36.0) in migraineurs and 110.2 (SD = 21.9) in TTH patients (p = 0.003) but there were no differences in Neutrophil lymphocyte ratio, lymphocyte monocyte ratio and D-dimer levels between both groups. There was also differences in vitamin D level between migraineurs and TTH patients with 19.5 ng/l (SD = 7.9 ng/l) in migraineurs and 26.7 ng/l (SD = 8,4 ng/l)in TTH patients (p = 0,001). There was no difference in magnesium levels in migraineurs and TTH patients (p = 0,692). Conclusion There were significant differences in the mean levels of platelets, CRP,Platelet lymphocyte ratio, and Vitamin D in migraineurs and TTH patients.

Latar Belakang Nyeri kepala dialami oleh hampir setiap orang diseluruh dunia terutama migren dan Tension Type Headache. Mekanisme patofisiologi yang mendasari penyakit ini masih menjadi perdebatan. Salah satu teori yang diajukan berkenaan dengan inflamasi dan nutrisi. Inflamasi dialami baik oleh migren ataupun TTH. Mikronutrien seperti vitamin D dan magnesium juga berperan dalam patofisiologi migren dan TTH Tujuan Penelitian ini dilakukan untuk mengetahui perbedaan parameter hematologi, penanda inflamasi, kadar vitamin D dan magnesium serum pasien migren dan TTH Metode Penelitian ini menggunakan desain potong lintang pada penderita migren dan TTH. Subjek yang mengikuti penelitian sebanyak 23 orang pada kelompok migren dan 23 orang pada kelompok TTH. Pada pasien kemudian dilakukan pemeriksaan parameter hematologi (hemoglobin, hematokrit, leukosit dan trombosit), penanda inflamasi (CReactive Protein (CRP), Rasio Neutrofil Limfosit (RNL), Rasio Trombosit Limfosit (RTL), Rasio Limfosit Monosit (RLM) dan D-dimer), kadar vitamin D dan magnesium Hasil Terdapat perbedaan rerata kadar trombosit pada pasien migren dan TTH dengan 355,3 x 103/μl (SD = 47,4 x 103/μl) pada pasien migren dan 282,0 x 103/μl (SD = 44,2 x 103/μl) pada pasien TTH (p = 0,001) namun tidak dijumpai perbedaan rerata pada parameter hematologi lainnya. Terdapat perbedaan rerata kadar CRP pasien migren dan TTH dengan 4,8 mg/l (SD = 3,7 mg/l) pada pasien migren dan 2,1 mg/l (SD = 1,8 mg/l) pada pasien TTH (p= 0,003). Terdapat perbedaan rerata RTL pasien migren dan TTH dengan 138,1 (SD = 36,0) pada pasien migren dan 110,2 (SD = 21,9) pada pasien TTH (p= 0,003) namun tidak dijumpai perbedaan rerata pada penanda inflamasi lainnya. Terdapat perbedaan rerata kadar vitamin D pasien migren dan TTH dengan 19,5 ng/l (SD = 7,9 ng/l) pada pasien migren dan 26,7 ng/l (SD = 8,4 ng/l) pada pasien TTH (p= 0,001). Tidak didapatkan perbedaan rerata kadar magnesium pasien migren dan TTH (p = 0,692). Kesimpulan Terdapat perbedaan signifikan rerata kadar trombosit, CRP, RTL dan Vitamin D pada pasien migren dan TTH.