Abstract Number: Esoc2026a2053 Enlarged Perivascular Spaces in Migraine With and Without Aura:a Cross-Sectional Mri Study

Abstract Background and aims Migraine, particularly migraine with aura (MA), has been linked to an increased risk of cerebrovascular events, suggesting possible differences in pathophysiology compared with migraine without aura (MO). Emerging evidence indicates that dysfunction of the glymphatic system may contribute not only to cerebral small vessel disease but also to migraine pathophysiology. Recent evidence indicates that migraine may involve glymphatic system dysfunction. This study compared glymphatic dysfunction between MA and MO by assessing enlarged perivascular spaces (ePVS) on MRI. Methods Participants with a clinical diagnosis of migraine who underwent 3T MRI brain were included. ePVS were evaluated in the centrum semiovale, basal ganglia, and midbrain using the validated Potter et al. rating scale and quantitative counts by two independent assessors. White matter hyperintensities (WMH) were graded using the Fazekas scale. Multivariable regression analyses were adjusted for age, sex, hypertension, and smoking status. Subgroup analyses examined associations with aura and migraine frequency. Results A total of 355 patients were included. ePVS counts did not differ significantly between MA and MO in the centrum semiovale (13 vs.14, p=0.63) or basal ganglia (4 vs 5, p=0.09). Migraine subtype was not significantly associated with ePVS burden in adjusted analyses, whereas age (β=0.32, 95% CI 0.24–0.40, p0.001) and hypertension (β=5.15, 95% CI 1.45–8.86, p0.001) were. ePVS counts correlated with periventricular (ρ=0.20, p0.001) and deep WMH (ρ=0.21, p0.001). Subgroup analyses revealed no significant differences. Conclusions Age, hypertension, and WMH were more strongly associated with ePVS than migraine subtype. Conflict of interest Estelle van Eijk. nothing to disclose. Vincent de Waal. nothing to disclose. Silke Lamberink. nothing to disclose. Annemijn Oosterlee. nothing to disclose. Gerrit Onderwater. nothing to disclose.I. de Boer reports independent research support from the Dutch Heart Foundation (2020T065) and Stichting Dioraphte. G.M. Terwindt reports grants or consultancy support from Abbvie, Lundbeck, Teva, Pfizer, and independent support from Dutch Heart Foundation, Stichting Dioraphte, Dutch Brain Foundation, Dutch Research Coundcil and European Community.