Differential Cerebral Perfusion Patterns Across Migraine Phenotypes: An Exploratory ASL MRI Study.

RATIONALE AND

OBJECTIVES

This study aims to characterize cerebral blood flow (CBF) alterations across migraine phenotypes and determine whether perfusion measures provide additional information for phenotype differentiation.

MATERIALS AND

METHODS

The final cohort comprised 143 patients with migraine and 49 healthy controls who underwent three-dimensional pseudo-continuous arterial spin labeling (ASL) MRI. Voxel-wise analyses of normalized CBF (nCBF) were performed to identify phenotype-related perfusion alterations. Sensitivity analyses repeated the voxel-wise comparisons with phenotype-appropriate clinical covariates. Exploratory correlation analyses examined associations between regional perfusion and clinical characteristics. Logistic regression was further used to assess whether perfusion measures provided additional information for differentiating migraine with aura (MA) from migraine without aura (MO).

RESULTS

Compared with healthy controls, migraine patients with depressive symptoms showed reduced nCBF in a right hippocampus-parahippocampal cluster (Cluster 1) in the primary voxel-wise analysis; however, this finding did not survive additional adjustment for sleep quality. Lower Cluster 1 nCBF was associated with greater headache frequency. Compared with MO, patients with MA showed increased nCBF in a right cerebellar-occipitotemporal cluster peaking in the right cerebellar Crus I (Cluster 2), and this difference remained significant after additional adjustment for sleep quality, medication-overuse headache status, and preventive medication exposure. Within the MA group, higher Cluster 2 nCBF was associated with greater headache intensity. In exploratory logistic regression analysis, the combined clinical-imaging model showed a higher apparent area under the curve (AUC) than the clinical model alone.

CONCLUSION

Clinically relevant migraine phenotypes showed distinct patterns of regional cerebral perfusion. These findings highlight the importance of considering clinical heterogeneity in migraine neuroimaging and suggest that ASL-derived perfusion measures may provide complementary biological information for phenotype characterization, particularly with respect to aura status.