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Glymphatic dysfunction in high-frequency episodic migraine: Evidence from DTI-ALPS and exploratory white matter
YingSheng Zhang1, JinFeng Zhou2, XiaoJun Feng3
1Department of Neurology, Fuyang Hospital Affiliated to Anhui Medical University, Fuyang, 236000, China; Department of Rehabilitation Medicine, Fuyang Hospital Affiliated to Anhui Medical University, Fuyang, 236000, China.
Objective:
To explore glymphatic function and white matter microstructural alterations in high-frequency episodic migraine (HFEM).
Methods:
This study included 31 healthy controls (HCs), 44 patients with low-frequency episodic migraine (LFEM), and 27 with HFEM. Glymphatic function was indirectly assessed using diffusion tensor image analysis along the perivascular space (DTI-ALPS), while white matter integrity was examined using tract-based spatial statistics (TBSS).
Results:
The ALPS index was higher in LFEM than HFEM. In the combined migraine cohort, it was negatively associated with attack frequency, showed a trend toward a negative association with the Migraine Disability Assessment Scale (MIDAS) score, and was positively associated with the visual analogue scale (VAS) score. Exploratory mediation analysis indicated that attack frequency showed a significant statistical mediating role in the association between the ALPS index and MIDAS score. No significant between-group differences in white matter FA survived correction for multiple comparisons in the TBSS analysis.
Conclusions:
The ALPS index showed a frequency-related pattern, with relatively higher values in LFEM and lower values in HFEM, suggesting differences in glymphatic function across attack-frequency stages of episodic migraine. Attack frequency showed a significant statistical mediating role in the association between glymphatic function and migraine-related disability. The exploratory TBSS analysis did not identify significant white matter FA differences after correction for multiple comparisons.
