Spectrum of complicated migraine in children: A common profile in aid to clinical diagnosis

Table 5 Shows select cerebrospinal fluid biochemical changes which help to distinguish between bacterial meningitis, aseptic meningitis, and migraine attacks[34-39]

Increased level in cerebrospinal fluid	Comments
Lactate	> 3.5 mmol/L is a good predictor of bacterial meningitis[34]
Procalcitonin	> 0.5 ng/mL is a good predictor of bacterial meningitis[35]
Ferritin	106.39 +/- 86.96 ng/ dL (n = 24) was considerably higher than the viral meningitis group (10.17 +/- 14.09, P < 0.001)[36]
Cytokines	Children with mumps meningitis (n = 19), echovirus 30 meningitis (n = 22), with comparison to children without meningitis (n = 21)[37]
Glutamic acid	An excess of neuroexcitatory amino acids during migraine attacks supports a state of neuronal hyperexcitability[38]
5-hydroxyindoleacetic acid	Level was higher in migraine than the controls[39]

Cerebrospinal fluid and systemic biochemical changes in migraine are complex, contradictory, and often unreplicated. Generally accepted CSF changes are as follows: (1) Changes in neuroexcitatory amino acids and magnesium; (2) Changes of vasoactive peptides in trigemino-vascular system; (3) Catecholaminergic changes suggesting sympathetic over activity; (4) Alterations in methionine-encephalin levels; and (5) Systemic changes include derangement of 5-Hydroxytryptophan metabolism hormonal fluctuations in female to precipitate migraine attack[40]. CSF: Cerebrospinal fluid.