Enlarged perivascular spaces in patients with migraine: a case–control study based on 3T MRI

Abstract

Objective To explore whether MRI‐visible enlarged perivascular spaces (EPVS) are associated with migraine and may serve as a predictor of migraine. Then further explore its correlation with migraine chronification. Methods A total of 231 participants (healthy control [HC] = 57, episodic migraine [EM] = 59, chronic migraine [CM] = 115) were included in this case–control study. A 3T MRI device and the validated visual rating scale were used to assess the grades of EPVS in centrum semiovale (CSO), midbrain (MB), and basal ganglia (BG). Comparisons between the two groups were made using the chi‐square or Fisher's exact tests to initially determine whether high‐grade EPVS were associated with migraine and migraine chronification. A multivariate logistic regression model was constructed to further investigate the role of high‐grade EPVS in migraine. Results The prevalence of high‐grade EPVS in CSO and MB were significantly higher in patients with migraine than in HCs (CSO: 64.94% vs. 42.11%, P = 0.002; MB: 55.75% vs. 29.82%, P = 0.001). Subgroup analysis showed no statistical difference between patients with EM and CM (CSO: 69.94% vs. 62.61%, P = 0.368; MB: 50.85% vs. 58.26%, P = 0.351). Individuals with high‐grade EPVS in CSO (odds ratio [OR]: 2.324; 95% confidence interval [CI]: 1.136–4.754; P = 0.021) and MB (OR: 3.261; 95% CI: 1.534–6.935; P = 0.002) were more likely to suffer from migraine. Interpretation This case–control study showed that high‐grade EPVS in CSO and MB in clinical practice with the underlying mechanism of dysfunction of the glymphatic system could be a predictor of migraine, but no significant correlation had been found with migraine chronification.

The glymphatic system in migraine and other headaches

“…Neuroinflammation, excess of calcitonin gene-related peptide (CGRP) and cortical spreading depression are the three most studied mechanisms underlying migraine pathogenesis and aura development. A common feature of these mechanisms is the impairment of the glymphatic system [ 2 , 5 , 7 – 23 ].…”

“…Within the CSF-ISF, it reaches the perivenous space and hence the bigger dura mater sinus. Then, the final step are the lymph nodes of the general lymphatic system [ 2 ]. It can been postulated that an impairment of the GS may increase CGRP concentration and thus worsen migraine.…”

“…It is one of the most frequent and disabling neurological diseases. It affects approximately 14% of the general population, mainly women, with a mean age of 15–40 years [ 2 ]. It represents a worldwide social and health concern [ 3 ].…”

Impaired Glymphatic and Meningeal Lymphatic Functions in Patients with Chronic Migraine

“…However, this study only recruited patients with EM, leaving patients at the worse end of the disease spectrum (ie, CM) unexplored. Another study found enlarged perivascular spaces in patients with migraine, implicating a potential role of glymphatic dysfunction in migraine 19 . However, this speculation has not been verified by the evaluation of glymphatic dynamics.…”

“…However, this speculation has not been verified by the evaluation of glymphatic dynamics. Moreover, the function of the mLVs in patients with migraine has not been explored 18,19 …”