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Background  Migraine can manifest with an episodic or a chronic pattern in a continuum of disease severity. Multiple factors are associated with the progression of the pattern from episodic to chronic. One of the most consistently reported factors is the overuse of medications (MO) for the acute treatment of migraine attacks. The mechanisms through which MO facilitates the transformation of episodic migraine (EM) into chronic migraine (CM) are elusive. In order to provide insights into these mechanisms, the present study aims to identify possible peripheral biomarkers associated with the two forms of migraine, and with the presence of MO.    Methods  We evaluated the plasma levels of calcitonin gene-related peptide (CGRP) and the expression of miR-34a-5p and miR-382-5p in peripheral blood mononuclear cells of subjects with EM ( n  = 27) or CM-MO ( n  = 28). Subjects in the CM-MO group were also tested 2 months after an in-hospital detoxification protocol.    Results  CGRP, miR-382-5p, and miR-34a-5p levels were significantly higher in CM-MO subjects when compared to EM patients ( p  = 0.003 for all comparisons). After correcting for age, sex, and disease duration, miRNAs expression was still significantly associated with migraine phenotype (EM vs. CM-MO:  p  = 0.014 for miR-382-5p,  p  = 0.038 for miR-34a-5p), while CGRP levels were not ( p  = 0.115). CGRP plasma levels significantly and positively correlated with miR-382-5p (Spearman’s rho: 0.491,  p  = 0.001) and miR-34a-5p (Spearman’s rho: 0.303,  p  =0.025) in the overall population. In the CM-MO group, detoxification significantly decreased CGRP levels and miRNAs expression ( p  = 0.001). When comparing responders and non-responders to the detoxification, the former group ( n  = 23) showed significantly higher levels of CGRP at baseline, and significantly lower expression of miR-382-5p after the detoxification.    Conclusions  Our findings identify a potential panel of peripheral markers associated with migraine subtypes and disease severity. CGRP levels as well as miRNAs expression were influenced by MO, and modulated by detoxification in subjects with CM-MO.    Trial registration  The study protocol was registered at www.clinicaltrials.gov ( NCT04473976 ).

the journal of headache and pain

Plasma levels of CGRP and expression of specific microRNAs in blood cells of episodic and chronic migraine subjects: towards the identification of a panel of peripheral biomarkers of migraine?