Choroid plexus volume and association with migraine Pathophysiology

Direct evidence of choroid plexus structures involved in the presumed peripheral-central interaction in migraine is exceptionally scarce and, thus, which demands further attention.

Our objective is to assess choroid plexus volumetric changes quantitatively in episodic and chronic migraine patients versus age and sex compared normal controls, and to elucidate the differences.

Total sixty-five participants including 18 episodic migraine patients, 16 chronic migraine patients and 31 normal controls were recruited and underwent brain MRI examinations with 3.0 T MR strength between September 2021 to May 2023. The choroid plexus of the ventricles was segmented automatically on T1-weighted MRI sequences using the FreeSurfer (Version 7.4.1) software. Lateral ventricular choroid plexus volume was normalized as the ratio of choroid plexus to ipsilateral lateral ventricle volume (CP/LV). Group differences were assessed cross-sectionally. The accuracy of CP/LV for prediction of migraine was assessed using the receiver operating characteristic curves analysis.

Patients with migraine were more anxious and depressive, with heavier headache burden and impaired cognitive ability. Statistical analysis revealed group differences of the CP/LV in the right side. CP/LV ration decreased in episodic migraine patients, but the CP/LV size increased in chronic migraine patients. CP/LV of the right side was able to differentiate episodic migraine from controls with area under the ROC curve (AUC) 0.696 (95 % CI: 0.550-0.818, sensitivity 100 %, specificity 46.8 %, and the cut-off value 0.0741, P < 0.05). The diagnostic efficacy was marginally higher in distinguishing chronic migraine from episodic migraine with AUC 0.715(95 % CI: 0.536-0.856, sensitivity 50 %, specificity 94.4 % and the cut-off value 0.0725, P < 0.05).

Our finding suggested dynamic alteration of Lateral ventricular choroid plexus volume in the pathogenesis of migraine. The normalized CP/LV was associated with different migraine subtype. The normalized CP/LV can be used as a potential imaging biomarker for migraine diagnosis.