Abstract
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 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.