The role of immature granulocytes as a novel biomarker in migraine: a prospective tertiary-care study.

BACKGROUND AND PURPOSE: Migraine has been associated with systemic inflammatory alterations in a limited number of studies, although the evidence remains inconsistent. In this context, immature granulocytes (IGs), early indicators of bone marrow activation, have been proposed as potential biomarkers in migraine research. The aim of this study was to evaluate IG levels in patients with episodic migraine during attack and interictal periods and to investigate their relationship with hematological inflammatory markers and clinical features.

METHODS

This prospective case-control study enrolled 53 patients with episodic migraine and 53 healthy controls matched for age and sex. Blood samples were collected during acute migraine attacks and interictal periods. Inflammatory parameters, including IG, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, lymphocyte-to-monocyte ratio (LMR), systemic inflammation response index (SIRI), and platelet indices were analyzed. Correlations with clinical characteristics such as headache frequency, aura, white matter lesions, and migraine disability assessment scale (MIDAS) scores were assessed.

RESULTS

IG levels did not differ significantly between migraineurs and controls. However, lower IG levels were associated with higher headache frequency (ρ = -0.453, p = 0.001) and MIDAS scores (ρ = -0.291, p = 0.037). LMR was significantly lower and SIRI higher in the attack-period patients versus controls (p = 0.028 and p = 0.023, respectively). Platelet indices such as MPV, PDW, and P-LCR elevated during attacks, while platelet counts increased during interictal periods. ROC analyses showed limited discriminative power of platelet indices (AUC < 0.61).

CONCLUSION

These findings suggest that IG levels and inflammatory indices such as LMR and SIRI may reflect migraine-related immune activity and disease burden during the migraine attack phase, though their clinical utility requires further validation.