From the Guidelines
Elevated C-reactive protein (CRP) during an acute migraine attack may indicate inflammation, but it's not typically used to diagnose migraines. For acute migraine treatment, start with NSAIDs like ibuprofen (400-600mg) or naproxen (500-550mg) at the first sign of headache. If these are ineffective, triptans such as sumatriptan (50-100mg orally, 6mg subcutaneously, or 20mg nasal spray) can be used. For severe migraines, combination therapy with NSAIDs plus triptans may be more effective. Anti-emetics like metoclopramide (10mg) can help with nausea. Rest in a dark, quiet room and apply cold compresses to the forehead. Stay hydrated and consider caffeine intake (up to 200mg) if it helps. The elevated CRP should be monitored but doesn't necessarily change acute treatment.
Some key points to consider:
- CRP is a marker of inflammation and has been linked to cardiovascular disease, as seen in studies such as 1 and 1.
- Elevated CRP levels have been associated with increased risk of cardiovascular events, as shown in 1.
- However, in the context of acute migraine, CRP elevation is more likely related to neurogenic inflammation and vasodilation, rather than cardiovascular disease.
- If CRP remains elevated between attacks or you experience frequent migraines (more than 4 per month), consult a healthcare provider about preventive treatments and to rule out other inflammatory conditions, as suggested by the study 1.
It's essential to note that while CRP can be an indicator of inflammation, its elevation during an acute migraine attack does not necessarily change the treatment approach. The primary focus should be on managing the migraine symptoms and preventing future attacks. If concerns about CRP elevation or other inflammatory conditions arise, consultation with a healthcare provider is recommended to determine the best course of action.
From the Research
Significance of Elevated C-Reactive Protein (CRP) in Acute Migraine
- Elevated CRP levels have been found to be significantly higher in patients with migraine than in controls, suggesting a potential epidemiological association between increased CRP concentration and migraine 2.
- A study found that CRP may be abnormal in patients with migraine without aura (MwoA) and migraine with aura (MwA) who present with atypical, severe, or complex clinical features 3.
- High sensitivity CRP (hs-CRP) levels were found to be significantly greater in migraine patients than in control subjects, indicating a proinflammatory state in migraine patients 4.
- The presence of cerebral white matter hyperintensities (WMHs) on magnetic resonance imaging (MRI) scans was significantly greater in migraine patients than in control subjects, but there was no correlation between hs-CRP level and WMHs in migraine patients 4.
Clinical Implications
- The association between elevated CRP levels and migraine suggests that inflammation may play a role in the pathogenesis of migraine 2, 3.
- The presence of elevated CRP levels in patients with acute migraine may indicate a higher risk of cardiovascular disease and stroke 2, 4.
- Further clinical investigations are needed to determine the therapeutic implications of elevated CRP levels in patients with acute migraine and to explore the potential benefits of treatments that reduce inflammation and CRP levels 2.
Treatment Options
- While the studies do not directly address the treatment of elevated CRP in acute migraine, they do discuss various treatment options for acute migraine, including triptans, nonsteroidal anti-inflammatory drugs (NSAIDs), and combination therapies 5, 6.
- The American Headache Society evidence assessment of migraine pharmacotherapies recommends several medications for the acute treatment of migraine, including sumatriptan/naproxen combination therapy 6.