Vasomotor reactivity measurement using Breath Holding Index to objectively diagnose migraine in Indonesia

Objective. Migraine is currently diagnosed using the subjective fulfilment of the International Headache Society (IHS) criteria. Considering the pathophysiology of endothelial dysfunction in migraine, this study aimed to utilize the breath holding index (BHI) to diagnose migraine objectively by assessing the vasodilatation response of intracranial arteries in migraine without aura. Material and method. 128 subjects with primary headache in the interictal phase were cross-sectional recruited and classified into migraine and non-migraine groups. BHI was performed using transcranial Doppler examination. Confirmed migraine was diagnosed using the validated IHS-equivalent Indonesian Migraine Screen Questionnaire (MS-Q) score of ≥4, BHI of <0.69, and one-month clinical response to topiramate and/or indomethacin administration based on the nature of their headache. Result. This study enrolled 104 and 24 subjects with migraine and non-migraine headache, respectively. The sociodemographic profile was similar between groups. Reduced ipsilateral BHI was more observed in the migraine than the non-migraine group (0.70 vs 1.53, p<0.001), with sensitivity of 49 (39-59) % and specificity of 92 (81-100) % using the established cut off value of 0.69. Conclusion. The breath holding index is a highly specific, moderately sensitive and objective tool to diagnose migraine. Measurement of vasoconstrictive response may be considered to further increase the sensitivity of this objective diagnostic tool.