Cai Xin, Sun Wei, Cai Mengfei, Li Dawei, Chen Zhenzhen, Li Hao, Yuan Bo, Li Yan, Liu Zaiyi, Zhang Yuhu
Department of Neurology, Guangdong Neuroscience Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences, Southern Medical University, No. 106 Zhongshan Er Road, Guangzhou, Guangdong Province, 510080, China.
Department of Neurology, The Fourth People's Hospital of Shenzhen (Shenzhen Samii Medical Center), No.1 Jinniu West Road, Shenzhen, 518118, China.
J Headache Pain. 2025 Jun 3;26(1):132. doi: 10.1186/s10194-025-02070-8.
Previous studies have reported inconsistent results regarding glymphatic function in migraine patients. This study aimed to investigate glymphatic function in patients with episodic migraine (EM), focusing on varying attack frequencies, and to explore its potential pathophysiologic role in migraine.
In this cross-sectional study, migraine clinical parameters and psychiatric comorbidities, including depression, anxiety, and sleep disorders, were collected. Three MRI measures were quantified, i.e., the diffusion tensor imaging (DTI) along the perivascular space (DTI-ALPS) index, perivascular space (PVS) volume in the basal ganglia (BG) and white matter (WM), and white matter hyperintensity (WMH) volume in the periventricular WM and deep WM. Patients with 4 or more monthly migraine days (MMDs) were categorized into the high-frequency episodic migraine (HFEM) group, whereas patients with fewer than 4 MMDs were placed in the low-frequency episodic migraine (LFEM) group. The differences in the DTI-ALPS index, PVS volume, and WMH volume were compared between the controls and patients with EM, as well as among the EM subgroups. Correlations between the DTI-ALPS index and migraine clinical parameters, WMH, and PVS were determined.
A total of 74 patients with EM without cardiovascular risk factors and 42 age- and sex-matched controls were enrolled. The HFEM group (1.37 ± 0.12) exhibited a significantly lower DTI-ALPS index compared to controls (1.45 ± 0.10; p = 0.011; CI:-0.15 to -0.014) and those with LFEM (1.44 ± 0.12; p = 0.022; CI: -0.14 to -0.008). The reduced DTI-ALPS index was correlated with several clinical parameters, including MMDs, photophobia, phonophobia, and severe headache-related disability. Compared with controls, EM patients presented larger WMH volumes, but no significant differences in PVS volumes were observed. Increased MMDs, long disease duration, the presence of phonophobia, and increased deep WMH volumes were independently associated with the reduced DTI-ALPS index in EM.
A reduced DTI-ALPS index, rather than larger PVS volume, may serve as a potential noninvasive measure of compromised glymphatic activity in migraine patients with high-frequency attacks, suggesting potential pathogenic mechanisms for central sensitization. Further longitudinal studies are warranted to investigate the causal relationship between glymphatic function and migraine attacks.
既往研究报道偏头痛患者的类淋巴功能结果不一致。本研究旨在调查发作性偏头痛（EM）患者的类淋巴功能，重点关注不同的发作频率，并探讨其在偏头痛中的潜在病理生理作用。
在这项横断面研究中，收集了偏头痛临床参数和精神共病情况，包括抑郁、焦虑和睡眠障碍。对三项磁共振成像（MRI）指标进行了量化，即沿血管周围间隙的扩散张量成像（DTI-ALPS）指数、基底节（BG）和白质（WM）中的血管周围间隙（PVS）体积，以及脑室周围WM和深部WM中的白质高信号（WMH）体积。每月偏头痛天数（MMD）为4天或更多的患者被归类为高频发作性偏头痛（HFEM）组，而MMD少于4天的患者被归入低频发作性偏头痛（LFEM）组。比较了对照组与EM患者以及EM亚组之间DTI-ALPS指数、PVS体积和WMH体积的差异。确定了DTI-ALPS指数与偏头痛临床参数、WMH和PVS之间的相关性。
共纳入74例无心血管危险因素的EM患者和42例年龄及性别匹配的对照组。HFEM组（1.37±0.12）的DTI-ALPS指数显著低于对照组（1.45±0.10；p=0.011；CI：-0.15至-0.014）和LFEM组（1.44±0.12；p=0.022；CI：-0.14至-0.008）。降低的DTI-ALPS指数与几个临床参数相关，包括MMD、畏光、畏声和严重的头痛相关残疾。与对照组相比，EM患者的WMH体积更大，但PVS体积未观察到显著差异。MMD增加、病程长、存在畏声以及深部WMH体积增加与EM患者DTI-ALPS指数降低独立相关。
降低的DTI-ALPS指数而非更大的PVS体积，可能是高频发作的偏头痛患者类淋巴活动受损的潜在非侵入性指标，提示中枢敏化的潜在致病机制。有必要进行进一步的纵向研究来调查类淋巴功能与偏头痛发作之间的因果关系。
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