ArticleThe journal of headache and pain2025
Impaired glymphatic function contributes to high-frequency attacks in patients with episodic migraine.
Article in The journal of headache and pain, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers, 1 of them a synthesis that pooled it.
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Who cites it
11 citing papers in PubMed, 1 synthesis or guideline pooled it.
- The emerging role of the meningeal lymphatic and glymphatic systems in migraine pathophysiology: a systematic review.The journal of headache and pain · 2026Pooled it
- Diffusion tensor image analysis along the perivascular space (DTI-ALPS): redefining its interpretation and role.Japanese journal of radiology · 2026Review
- Glial cells in neuropathic pain.Physiological reviews · 2026Review
- Periventricular diffusivity at the ventricular-parenchymal interface across healthy controls, episodic migraine, and chronic migraine: a cross-sectional multimodal MRI study.The journal of headache and pain · 2026Article
- Glymphatic system impairment in neurological disorders: potential mechanisms and therapeutic targets.Molecular biomedicine · 2026Review
- Overlapping pathways of migraine and the endocannabinoid system: Potential therapeutic targets.Neurotherapeutics : the journal of the American Society for Experimental NeuroTherapeutics · 2026Review
- Non-neuronal targets for migraine therapy.Neurotherapeutics : the journal of the American Society for Experimental NeuroTherapeutics · 2026Review
- Why sleep matters in chronic pain: evidence across the lifespan.EBioMedicine · 2026Review
- Beyond AQP-4: convergent glymphatic-meningeal lymphatic dysfunction underlying multifactorial migraine pathogenesis.Frontiers in immunology · 2026Review
- Impaired meningeal lymphatic drainage correlates with headache intensity in episodic migraine.The journal of headache and pain · 2025Article
- Abnormal neurovascular coupling induces glymphatic dysfunction in a mouse model of familial hemiplegic migraine type 2.The journal of headache and pain · 2025Article
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10 authors.
Funding
Abstract
BACKGROUND AND
objectivePrevious 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.
methodsIn 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.
resultsA 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.
conclusionA 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.
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