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Published on: June 2, 2014
Periventricular diffusivity at the ventricular-parenchymal interface across healthy controls, episodic migraine, and
Fangwang Fu1,2, Chenyu Dai1,2, Chenyu Lin1,2
1Department of Neurology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, 325027, China.
Background:
Chronic migraine (CM) carries high disability, yet interictal MRI phenotypes that distinguish CM from episodic migraine (EM), particularly in medication-overuse headache (MOH)-inclusive cohorts, remain incompletely characterized. We tested whether periventricular diffusivity (PVeD), an indirect MRI marker of tissue-water properties at the ventricular-parenchymal interface, is associated with CM and headache burden.
Methods:
In this cross-sectional 3.0-T multimodal MRI study, 289 adults with complete structural MRI, diffusion MRI, and resting-state fMRI were analyzed: 67 healthy controls, 162 EM, and 60 CM. MOH was diagnosed and retained in the CM group. MRI was acquired during verified interictal evening sessions; participants with headache within 24 hours before or after MRI were excluded. The primary contrast was age- and sex-adjusted CM versus EM for PVeD. Secondary analyses examined MOH strata, headache-frequency strata, partial Spearman correlations, Firth logistic regression for CM status, and HIT-6 models.
Results:
Age- and sex-adjusted PVeD was lower in CM than EM (adjusted difference, -0.011; 95% CI, -0.017 to -0.006; standardized difference, -0.71; p < 0.001) and healthy controls (-0.014; 95% CI, -0.021 to -0.007; standardized difference, -0.88; p < 0.001), with no EM-control difference. Both CM participants with and without MOH had lower PVeD than EM. In migraine participants, lower PVeD correlated with higher headache frequency, HIT-6, and MIDAS and with larger choroid plexus volume and smaller thalamic, nucleus accumbens, and putaminal volumes. In the expanded clinical-plus-MRI Firth model, each 1-SD higher PVeD was associated with lower CM odds (OR, 0.59; 95% CI, 0.38 to 0.89; p = 0.011). Higher PVeD was associated with lower HIT-6 after adjustment for headache frequency or MOH.
Conclusions:
CM was associated with lower PVeD at the ventricular-parenchymal interface, and lower PVeD was linked to patient-centered burden in this MOH-inclusive cohort. PVeD is not yet a diagnostic or treatment-selection biomarker, but may help define an MRI phenotype for future chronification-risk and treatment-response studies after longitudinal and external validation.
Insights
Chronic migraine (CM) is associated with lower periventricular diffusivity (PVeD), an MRI marker. Lower PVeD correlates with increased headache burden and may help identify patients for future chronification-risk and treatment-response studies.
Area of Science:
- Neurology
- Radiology
- Neuroimaging
Background:
- Chronic migraine (CM) presents significant disability, but distinct interictal MRI phenotypes compared to episodic migraine (EM) are not fully understood, especially in medication-overuse headache (MOH) cohorts.
- Periventricular diffusivity (PVeD), an MRI marker of tissue-water properties, has not been extensively studied in relation to CM and headache burden.
Purpose of the Study:
- To investigate the association between PVeD and CM in a cohort including patients with MOH.
- To determine if PVeD can differentiate CM from EM and healthy controls.
- To explore the relationship between PVeD and patient-centered headache burden.
Main Methods:
- A cross-sectional 3.0-T multimodal MRI study analyzed 289 adults (67 healthy controls, 162 EM, 60 CM), including MOH diagnoses within the CM group.
- MRI data (structural, diffusion, resting-state fMRI) were acquired during interictal periods, excluding participants with recent headache.
- Primary analysis compared age- and sex-adjusted PVeD between CM and EM groups, with secondary analyses examining MOH, headache frequency, and clinical outcomes.
Main Results:
- Lower PVeD was significantly associated with CM compared to EM and healthy controls (p < 0.001).
- Both CM with and without MOH exhibited lower PVeD than EM.
- In migraineurs, lower PVeD correlated with higher headache frequency, HIT-6, MIDAS scores, and altered subcortical volumes (thalamus, nucleus accumbens, putamen).
Conclusions:
- CM is associated with reduced PVeD at the ventricular-parenchymal interface.
- Lower PVeD is linked to increased patient-reported headache burden in this MOH-inclusive cohort.
- PVeD shows potential as an MRI phenotype for future studies on migraine chronification risk and treatment response, pending validation.
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