Impaired glymphatic function and advanced brain age gap in chronic migraine: a multimodal MRI study

Area of Science:

• Neuroscience
• Medical Imaging
• Glymphatic System Research

Background:

• Migraine disability, measured by MIDAS, is linked to brain age gap (BAG), an indicator of accelerated brain aging.
• The glymphatic system clears waste from the brain, and its function may be impaired in migraine.
• BOLD-CSF coupling offers an indirect measure of glymphatic-associated dynamics.

Purpose of the Study:

• To investigate if BOLD-CSF coupling moderates the relationship between migraine disability (MIDAS) and brain age gap (BAG).
• To explore the role of glymphatic-associated dynamics in the pathophysiology of chronic migraine.

Main Methods:

• Recruited patients with episodic migraine (EM), chronic migraine (CM), and healthy controls.
• Estimated BAG using deep learning; assessed BOLD-CSF coupling for hemodynamic-CSF dynamics.
• Used a moderation model to analyze the effect of BOLD-CSF coupling on the MIDAS-BAG association, controlling for sleep quality and covariates.

Main Results:

• Identified network-specific BOLD-CSF coupling alterations, particularly in higher-order networks in CM patients.
• CM patients showed a significantly larger BAG compared to EM patients and controls.
• BOLD-CSF coupling significantly moderated the MIDAS-BAG association; stronger coupling amplified the association.

Conclusions:

• Altered BOLD-CSF coupling in higher-order networks may be an imaging biomarker for migraine chronification.
• BOLD-CSF coupling influences the relationship between migraine disability and brain age, independent of sleep quality.
• Findings highlight the potential role of glymphatic-related processes in chronic migraine pathophysiology.