Normal glymphatic system function in patients with new daily persistent headache using diffusion tensor image analysis along the perivascular space

Abstract

Objectives To investigate the glymphatic function in patients with new daily persistent headache (NDPH) using the diffusion tensor image analysis along the perivascular space (DTI‐ALPS) method. Background NDPH, a rare and treatment‐refractory primary headache disorder, is poorly understood. There is limited evidence to suggest that headaches are associated with glymphatic dysfunction. Thus far, no studies have evaluated glymphatic function in patients with NDPH. Methods In this cross‐sectional study conducted in the Headache Center of Beijing Tiantan Hospital, patients with NDPH and healthy controls were enrolled. All participants underwent brain magnetic resonance imaging examinations. Clinical characteristics and neuropsychological evaluation were examined in patients with NDPH. ALPS indexes for both hemispheres were measured to determine the glymphatic system function in patients with NDPH and healthy controls. Results In total, 27 patients with NDPH (14 males, 13 females; age [mean ± standard deviation (SD)]: 36.6 ± 20.6) and 33 healthy controls (15 males, 18 females; age [mean ± SD]: 36.0 ± 10.8) were included in the analysis. No significant differences between groups were observed in the left ALPS index (1.583 ± 0.182 vs. 1.586 ± 0.175, mean difference = 0.003, 95% confidence interval [CI] of difference = −0.089 to 0.096, p = 0.942), or right ALPS index (1.578 ± 0.230 vs. 1.559 ± 0.206, mean difference = −0.027, 95% CI of difference = −0.132 to 0.094, p = 0.738). Additionally, ALPS indexes were not correlated with clinical characteristics or neuropsychiatric scores. Conclusion No glymphatic dysfunction was detected in patients with NDPH by means of the ALPS method. Additional studies with larger samples are needed to confirm these preliminary findings and improve the understanding of glymphatic function in NDPH.

Evaluating the glymphatic system via magnetic resonance diffusion tensor imaging along the perivascular spaces in brain tumor patients

“…This is consistent with the findings of other DTI-ALPS tumorrelated studies [9][10][11]. Previous studies investigating the DTI-ALPS index difference between males and females reached the same conclusion [8,14,16,17,35,[38][39][40][41], where there is no significant difference between sexes. However, contradictory results have been reported by Hsiao et al [42] and Zhang et al [43], where the DTI-ALPS index in women was larger than in men.…”

Impaired Glymphatic and Meningeal Lymphatic Functions in Patients with Chronic Migraine

“…[47][48][49] Recent studies have investigated the glymphatic function in different headache disorders using DTI-ALPS index. For example, normal glymphatic function was identified in new daily persistent headache (NDPH) 50 and impaired function was found in cluster headache. 51 Although NDPH is also a chronic daily headache that may share some clinical features with CM, 52 the disease is distinct from CM in terms of pathophysiology.…”

Dynamic changes in glymphatic function in reversible cerebral vasoconstriction syndrome

“…Our data further support the potential use of the DTI-ALPS index in the evaluation of subjects with RCVS regarding clinical impacts and implicate the potential role of glymphatics in pain modulation. Several recent studies also enhanced the roles of glymphatic system in headache disorders (Supplementary Table 9 in Additional file 1 ) [ 19 , 31 , 32 , 49 – 55 ]. Nevertheless, since some studies depicted normal glymphatic functions in certain headache disorders, including episodic migraine [ 19 , 52 ] and new daily persistent headache, [ 24 ] and some demonstrated contradictory findings, [ 32 ] the potential mechanism of glymphatics in pain or headache modulation remains to be explored.…”