Overview: A new neuroimaging study identifies migraine patients with enlarged perivascular spaces in a brain region called the centrum semioval.
For the first time, a new study has identified enlarged perivascular spaces in the brains of migraine sufferers.
The results of the study will be presented next week at the annual meeting of the Radiological Society of North America (RSNA).
“In people with chronic migraines and episodic migraines without aura, there are significant changes in the perivascular spaces of a brain region called the centrum semioval,” said study co-author Wilson Xu, an MD candidate at the University’s Keck School of Medicine. of Southern California in Los Angeles. “These changes have never been reported before.”
Migraine is a common, often debilitating condition associated with severe recurrent headaches. Migraines can also cause nausea, weakness, and light sensitivity. According to the American Migraine Foundation, more than 37 million people in the US suffer from migraines and up to 148 million people worldwide suffer from chronic migraines.
Perivascular spaces are fluid-filled spaces around blood vessels in the brain. They are usually located in the basal ganglia and white matter of the cerebrum and along the optic tract.
Perivascular spaces are affected by several factors, including blood-brain barrier abnormalities and inflammation. Enlarged perivascular spaces may be a signal of underlying small blood vessel disease.
“Perivascular spaces are part of a fluid clearance system in the brain,” Xu said. “By studying how they contribute to migraines, we can better understand the complexities of how migraines occur.”
Xu and colleagues sought to determine the link between migraines and enlarged perivascular spaces. The researchers used ultra-high-field 7T MRI to compare structural microvascular changes in different types of migraine.
“To our knowledge, this is the first study using ultra-high-resolution MRI to study microvascular changes in the brain due to migraine, particularly in perivascular spaces,” Xu said.
“Because 7T MRI can create images of the brain with much higher resolution and better quality than other MRI types, it can be used to show much smaller changes in brain tissue after a migraine.”
Study participants included 10 with chronic migraine, 10 with episodic migraine without aura, and five age-matched healthy controls. All patients were between 25 and 60 years old. Patients with overt cognitive impairment, brain tumors, prior intracranial surgery, MRI contraindications, and claustrophobia were excluded from the study.
The researchers calculated enlarged perivascular spaces in the centrum semioval (central region of white matter) and basal ganglia regions of the brain. White matter hyperintensities — lesions that “light up” on MRI — were measured using the Fazekas scale.
Cerebral microbleeds were graded using the Anatomical Microbleed Rating Scale. The researchers also collected clinical data such as duration and severity of illness, symptoms at time of scan, presence of aura, and side headache.
Statistical analysis revealed that the number of enlarged perivascular spaces in the center semioval was significantly higher in patients with migraine compared to healthy controls. In addition, the increased amount of perivascular space in the center semioval correlated with the severity of deep white matter hyperintensity in migraineurs.
“We studied chronic migraine and episodic migraine without aura and found that for both types of migraine, the perivascular spaces were larger in the center semioval,” Xu said.
“While we found no significant changes in the severity of white matter lesions in patients with and without migraine, these white matter lesions were significantly associated with the presence of enlarged perivascular spaces. This suggests that changes in perivascular spaces may lead to the future development of more white matter lesions.”
The researchers hypothesize that significant differences in the perivascular spaces in patients with migraine compared to healthy controls may indicate glymphatic disruption in the brain.
The glymphatic system is a waste removal system that uses perivascular channels to remove soluble proteins and metabolites from the central nervous system.
However, it is unknown whether such changes influence the development of migraine or are due to migraine. Continued research with larger case populations and longitudinal follow-up will better establish the relationship between structural changes and the development and type of migraine.
“The results of our study may help inspire future, larger-scale studies to further investigate how changes in the brain’s microscopic vessels and blood supply contribute to different types of migraines,” Xu said. “Ultimately, this could help us develop new, personalized ways to diagnose and treat migraines.”
Co-authors are Brendon Chou, Giuseppe Barisano, Raymond Huang, Soniya Pinto, MD, Daniel Chang Phung, MD, Soma Sahai-Srivastava, Alexander Lerner, MD, and Nasim Sheikh Bahaei, MD, FRCR.
About this migraine and neurological research news
Author: Linda Brooks
Contact: Linda Brooks—RSNA
Image: The image is credited to RSNA and Wilson Xu
Original research: The findings will be presented at the 108th Scientific Meeting and Annual Meeting of the Radiological Society of North America