NRF2/HO-1 axis and oxidative stress in pediatric migraine with and without aura

Abstract

Objective: Migraine is a frequent neurological disorder in childhood. Oxidative stress plays an important role in its pathophysiology. Nuclear factor erythroid 2–related factor 2 and heme oxygenase-1 regulate the antioxidant defense system. This study evaluated their serum levels and oxidative stress markers in pediatric migraine with and without aura.

Methods: Sixty pediatric migraine patients (34 with aura, 26 without aura) and 27 healthy controls were included. Serum nuclear factor erythroid 2–related factor 2 and heme oxygenase-1 were measured by ELISA, and total antioxidant status, total oxidant status, and oxidative stress index were determined.

Results: In both migraine subgroups, nuclear factor erythroid 2–related factor 2, heme oxygenase-1, and total antioxidant levels were lower, while the total oxidant status and oxidative stress indexes were higher compared to controls (p < 0.01). Subgroup analysis showed no differences between migraine with and without aura. In all patients, nuclear factor erythroid 2–related factor 2 correlated negatively with total oxidant status and oxidative stress index, and positively with total antioxidant status (p < 0.01).

Conclusions: Pediatric migraine patients show reduced nuclear factor erythroid 2–related factor 2 and heme oxygenase-1 as well as altered oxidative stress markers, indicating antioxidant dysregulation. The nuclear factor erythroid 2–related factor 2/heme oxygenase-1 axis may represent a biomarker for early identification of high-risk pediatric patients, and therapies targeting this pathway could provide a novel treatment approach.