Impaired meningeal lymphatic drainage correlates with headache intensity in episodic migraine
Abstract
BACKGROUND: Migraine pathophysiology involves trigeminovascular activation and neuroinflammation, with neuropeptides such as calcitonin gene-related peptide (CGRP) playing a key role. Growing evidence implicates glymphatic system dysfunction, particularly meningeal lymphatic vessel (mLV) mediated cerebrospinal fluid (CSF) and waste clearance, as a potential contributor. However, multi-level imaging assessments glymphatic system in episodic migraine (EM) remain limited. METHODS: We prospectively enrolled 38 EM patients and 22 age- and sex- comparable healthy controls (HCs). Glymphatic function was systematically evaluated using 3T MRI. Dynamic contrast-enhanced MRI (DCE-MRI) was used to quantify mLV drainage kinetics including Wash-in rate, Time-to-Peak (TTP), Initial Area Under Curve (IAUC) and Ktrans along the superior sagittal sinus (mLV-SSS) and sigmoid sinus (mLV-SS). Diffusion tensor imaging along perivascular spaces (DTI-ALPS) index was used to assess parenchymal interstitial fluid dynamics. Structural MRI was used to rate enlarged perivascular spaces (EPVS) in centrum semiovale (CSO), basal ganglia (BG), and midbrain (MB). Finally, the correlations among clinical characteristics and neuroimaging data were analyzed. RESULTS: Compared to HCs, EM patients showed impaired meningeal lymphatic drainage on DCE-MRI, with reduced wash-in rate, prolonged TTP, and lower IAUC and Ktrans in both mLV-SSS and mLV-SS. Within the EM cohort, these kinetic abnormalities were associated…
How strong is the evidence?
Evidence Hub reads this as a cohort study, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence. Reported size: 38 participants or records.
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