Abstract
Background
Pediatric headache is a common neurological condition that adversely affects quality of life. Vitamin B12 is involved in homocysteine (Hcy) and methylmalonic acid (MMA) metabolism, and nitric oxide (NO) plays a role in neurovascular signaling. This study evaluated vitamin B12–related biomarkers and NO in pediatric migraine and tension-type headache (TTH).
Methods
The study included 39 migraine, 42 TTH and 29 control. Vitamin B12 and folic acid were measured using the Roche Cobas e601, Hcy were measured with the Shimadzu LC-20 HPLC, MMA were measured by a modified LC-MS/MS method, NO were measured using the Griess method.
Results
Hcy levels differed significantly between the migraine and control, as well as between the TTH and control (p<0.05). For MMA, a significant difference was observed between the TTH and control groups (p<0.05). Total nitrite and nitrate concentrations were significantly higher in patients than in controls(p<0.05).
Conclusions
Although serum vitamin B12 concentrations did not show a significant difference, median MMA values were elevated in the patient groups. MMA is recognized as a biomarker of subclinical vitamin B12 deficiency, and because oxidative stress may impair the cellular function of vitamin B12, MMA measurement provides valuable information even when serum B12 levels remain within the normal range. Furthermore, endothelial damage induced by Hcy, together with chronic oxidative stress associated with the Hcy–NO pathway, may contribute to the pathogenesis of pediatric migraine and TTH. Consistent with this, the significantly higher levels of NO metabolites in patients compared with controls suggest that NO may play a role in the development of migraine and TTH in the pediatric population.