Altered Choroid Plexus Volume and Association with Migraine Pathophysiology

Abstract

Abstract Background Although compelling evidences suggest that cortical spreading depression and the trigeminovascular system activation are the main mechanisms underlying the migraigenesis, it remains “a nearly complete mystery of how the migraine starts”. Direct evidence of choroid plexus structures involved in the presumed peripheral-central interaction in migraine is exceptionally scarce and, thus, which demands further attention. Objectives Our objective is to assess choroid plexus volumetric changes quantitatively in episodic and chronic migraine patients versus age and sex compared normal controls, and further to elucidate the migraine pathophysiology. Methods Total sixty-five participants including 18 episodic migraine patients, 16 chronic migraine patients and 31 normal controls were recruited and underwent a brain MR examination with 3.0T MR strength between September 2021 to May 2023. The choroid plexus of the ventricles was segmented fully automatically on T1-weighted MRI sequences using the FreeSurfer (Version 5.3.0) software. Lateral ventricular choroid plexus volume was expressed as the ratio of choroid plexus to ipsilateral lateral ventricle volume (CP/LV). Group differences were assessed cross-sectionally. The accuracy of CP/LV for prediction of migraine was assessed using the receiver operating characteristic curves analysis. Results Patients with migraine were more anxious and depressive, with heavier headache burden and impaired cognitive ability. Statistical analysis revealed group differences of the CP/LV in the right side. CP/LV ration decreased in episodic migraine patients, but the CP/LV size increased with the prolongation of the disease duration. CP/LV of the right side was able to differentiate episodic migraine from controls with area under the ROC curve (AUC) 0.696 (95% CI: 0.550–0.818, sensitivity 100%, specificity 46.8%, and the cut-off value 0.0741, P < 0.05). The diagnostic efficacy was marginally higher in distinguishing chronic migraine from episodic migraine with AUC 0.715(95% CI: 0.536–0.856, sensitivity 50%, specificity 94.4% and the cut-off value 0.0725, P < 0.05). Conclusion Our finding suggested dynamic alteration of choroid plexus in the pathogenesis of migraine. The CP/LV volume was associated with the migraine duration. CP/LV volume can be used as a potential imaging biomarker for migraine diagnosis.