The platelet-to-HDL ratio as a novel integrative biomarker for migraine: insights from NHANES and CHARLS

BackgroundSystemic inflammation is widely recognized as a driver of migraine pathophysiology, yet the integrative role of coagulation and lipid metabolism remains poorly defined. We evaluated the Platelet-to-High-Density Lipoprotein Ratio (PHR), a novel biomarker representing the balance between pro-thrombotic activity and vascular protection, to determine its association with migraine prevalence in two large national cohorts.MethodsWe conducted cross-sectional analyses using data from the National Health and Nutrition Examination Survey (NHANES 1999–2004, n=4,764) and the China Health and Retirement Longitudinal Study (CHARLS 2015, n=10,790). Migraine status was identified through validated self-report modules in both databases. Multivariable logistic regression and restricted cubic spline (RCS) models were applied to assess both linear and non-linear dose–response patterns after adjusting for potential socio-demographic and metabolic confounders.ResultsIn the NHANES cohort, higher PHR was independently associated with increased odds of migraine, exhibiting a consistent linear trend (adjusted OR = 1.001 per 1-unit increase, 95% CI: 1.000–1.002; P = 0.014). Although the linear association was not statistically significant in the CHARLS cohort (P = 0.074), RCS analysis revealed a robust U-shaped relationship (Wald χ² for non-linearity = 13.95, P = 0.0009). This suggests that both low and high extremes of the PHR index are linked to elevated migraine prevalence in the Chinese population.ConclusionPHR is significantly associated with migraine status in both US and Chinese populations, though the specific dose–response morphology appears to be sensitive to population characteristics. These findings highlight the importance of considering non-linear modeling when evaluating inflammatory biomarkers and suggest that PHR may serve as a cost-effective tool for risk stratification in diverse clinical settings.