Chronic Migraine Is Associated With Region-Specific High-Grade Enlarged Perivascular Spaces: Retrospective Matched Case-Control Study

Abstract

Background and Purpose Enlarged perivascular spaces (EPVS) observed on magnetic resonance imaging (MRI) reflect impaired glymphatic system (GS) function; however, their association with chronic migraine remains unclear. This study aimed to investigate whether chronic migraine is associated with a high burden of region-specific high-grade EPVS. Methods This retrospective case-control study included 44 patients with chronic migraine, 44 age- and sex-matched patients with episodic migraine, and 39 matched healthy controls. Brain MRI scans were assessed for EPVS in the centrum semiovale (CS), basal ganglia, and midbrain (MB) using a validated visual rating scale. High-grade EPVS was defined according to region-specific criteria. Logistic regression analyses were performed to evaluate the association between chronic migraine and high-grade EPVS, adjusting for age, sex, hypertension, alcohol consumption, and insomnia. Results The prevalence of high-grade EPVS in the CS and MB differed significantly among the chronic migraine, episodic migraine, and control groups. Post-hoc analysis revealed a significantly higher prevalence in the chronic migraine group compared to controls in both regions, and compared to the episodic migraine group in the CS. Chronic migraine was independently associated with high-grade EPVS in the CS (adjusted odds ratio [OR]=9.345, p<0.001) and MB (adjusted OR=4.026, p=0.007). Conclusions Chronic migraine is associated with an increased prevalence of high-grade EPVS in specific brain regions, suggesting an underlying GS dysfunction. Thus, EPVS is a potential imaging biomarker of chronic migraine.