Evidence map›Paper›PMID 42804153›Full record

ArticlePain and therapy2026

Glymphatic-Hippocampal Axis Alterations Across the Migraine-Medication Exposure Continuum: A Multi-modal Neuroimaging Study.

Ange Li, Qiongfeng Guan, Weinv Fan, Guoping Chen, Bin Chen, Li Li, Zhenyi Fan, Yunqin Wu

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In one paragraph

Article in Pain and therapy, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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1 · What the graph read from it

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4 · The record

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5 · Who and what money

Authors and funding

8 authors.

Ange LiDepartment of Neurology, Ningbo No.2 Hospital, Wenzhou Medical University, Ningbo, 315010, Zhejiang, China.
Qiongfeng GuanDepartment of Neurology, Ningbo No.2 Hospital, Wenzhou Medical University, Ningbo, 315010, Zhejiang, China.
Weinv FanDepartment of Neurology, Ningbo No.2 Hospital, Wenzhou Medical University, Ningbo, 315010, Zhejiang, China.
Guoping ChenDepartment of Radiology, Ningbo No.2 Hospital, Wenzhou Medical University, Ningbo, 315010, Zhejiang, China.
Bin ChenDepartment of Radiology, Ningbo No.2 Hospital, Wenzhou Medical University, Ningbo, 315010, Zhejiang, China.
Li LiDepartment of Neurology, Ningbo No.2 Hospital, Wenzhou Medical University, Ningbo, 315010, Zhejiang, China.
Zhenyi FanDepartment of Neurology, Ningbo No.2 Hospital, Wenzhou Medical University, Ningbo, 315010, Zhejiang, China.
Yunqin WuDepartment of Neurology, Ningbo No.2 Hospital, Wenzhou Medical University, Ningbo, 315010, Zhejiang, China. wu_yunqin@126.com.ORCID http://orcid.org/0000-0002-1826-0156

Funding

Laboratoire d'Excellence en Recherche sur le Médicament et l'Innovation Thérapeutique No. SIML-202306the DCMST.NHC Clinical Research Project No. WKZX2025CZ0205the Hwa Mei Foundation No. 2023HMKY45the Ningbo Municipal Health and Wellness Science and Technology Program No. 2023Y18Zhejiang Medical and Health Program No.2025KY1385
6 · The paper itself

Abstract

introductionMedication-overuse headache (MOH) is a debilitating consequence of analgesic use, yet its pathophysiology remains incompletely characterised. Impaired glymphatic clearance may contribute to headache chronification. We investigated whether glymphatic-structural alterations progress across the migraine-medication exposure continuum and their biomarker potential.

methodsThis cross-sectional study enrolled 149 right-handed participants: 29 MOH patients, 34 patients with migraine and moderate medication use (MM), 46 medication-naive migraine patients (MN), and 40 healthy controls (HCs). The diffusion tensor imaging along the perivascular space (DTI-ALPS), perivascular space volume fraction (PVSVF), free water, and regional brain volumes were quantified. Group differences, imaging-clinical correlations, and diagnostic utility were assessed.

resultsRight-hemispheric centrum semiovale (CSO) PVSVF increased progressively across the continuum (HC < MN < MM < MOH; linear trend p = 0.003), with elevation in MOH versus controls (Cohen's d = 0.59, p = 0.014). Hippocampal volume was reduced in all migraine groups, most in MOH (d =  - 0.61, p = 0.001). DTI-ALPS and free water showed no group differences. Lower DTI-ALPS was associated with higher hippocampal free water in MOH (r =  - 0.539, p

conclusionA graded, cross-sectional increase in perivascular space burden and reduced hippocampal volume, with right-hemispheric predominance, were observed across the migraine-medication exposure continuum. These markers may serve as adjunctive tools for MOH evaluation, meriting independent cohorts.

Indexed as

DTI-ALPSGlymphatic systemHippocampusMedication-overuse headacheMigrainePerivascular space

Identifiers

PMID42804153

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