T he role of homocysteine in the pathogenesis of migrane.

T here are recent evidences that homocysteine may be involved as a risk factor for cerebral infarction. An association between migraine and hypercoagulopathic states has also been observed. Besides, there is a probable connection between oxidative stress, homocysteine and cerebral ischaemia. The aim of our work was to evaluate, in a set of subjects with migraine, the plasmatic levels of copper, iron, folate, vitamin B12 and homocysteine. Besides, in hyperhomocysteinemic patients we gave an additional therapy of folate and vitamin B12 to evaluate their efficacy. One hundred and fifty patients (of which 112 were women), with mean age 37.4 years (SD 16.8), suffering from migraine with aura (26) and without aura (124) (International Headache Society, 2004 criteria) were studied. Fifty patients out of them, with basal hyperhomocysteinemia, were treated with vitamin B12 and folate for 60 days. We found basal blood hyperhomocysteine in 24% of the patients (55% with migraine plus aura and 45% with migraine minus aura), having blood levels of folate and vitamin B12 lower than normal while copper and iron levels were within the normal range. Anova test done during the follow-up, to compare migraine indices of treated subjects with those of controls as well as their respective basal values, showed significant (P<0.05) differences in treated patients, in whom basal blood homocysteine levels were decreased to 40%. Our data indicate that the administration of folates and vitamin B12 is able to produce a reduction of the migraine index and plasma levels of homocysteine. Therefore, homocysteine, probably by a modification of vasoactive endothelial factors (especially NO and thrombomoduline), could play an important role in migraine.