The following is a summary of “S100B Serum Level as a Potential Biomarker for Non-Traumatic Headache Management in Emergency Care,” published in the June 2023 issue of Emergency Medicine by Mercier, et al.

In emergency units, the diagnosis of primary or secondary headaches often relies on brain imaging, which can be costly and difficult to access. Previous research showed that increased serum S100B protein is associated with various neurological conditions that cause brain damage. For a study, researchers sought to evaluate the diagnostic accuracy of S100B serum assay in distinguishing between primary and secondary headaches among patients with non-traumatic headaches in the emergency department.

The prospective, monocentric diagnostic study included 81 adult patients with non-traumatic headaches in the emergency department. Along with standard management, blood samples for S100B protein assay were taken, and a brain MRI was performed between 48 and 96 hours if not already conducted during initial management. Unaware of the S100B assay results, an expert committee diagnosed the primary or secondary headache one month later. The primary outcome was the S100B protein blood assay.

The analysis included 63 patients with primary headaches and 17 with secondary headaches. S100B protein assay levels were significantly higher in patients with secondary headaches than primary headaches, with an Area Under the Curve (AUC) of the Receiver Operating Characteristic (ROC) curve of 0.67. The optimal threshold of 0.06 μg.L^-1 resulted in the following diagnostic characteristics: sensitivity 75% [48; 93], specificity 62% [48; 74], positive predictive value (PPV) 35% [20; 54], and negative predictive value (NPV) 90% [76; 97]. The association between S100B protein level and pain onset was significantly higher in patients with headaches lasting less than 3 hours.

The S100B protein assay could prove valuable in managing headaches in emergencies. Future studies should consider the timing of blood sampling and different etiologies to refine its practical use in clinical practice further.

Source: sciencedirect.com/science/article/abs/pii/S0735675723001523