Diffusion Tensor Imaging-Based Glymphatic Dysfunction Assessments in Migraine Syndromes: Mechanisms and Diagnostic Implications

Migraine is a common neurological disorder. Impaired glymphatic clearance has been recently implicated in the pathogenesis of migraine. Diffusion tensor imaging (DTI) metrics have been explored as a tool for assessing glymphatic status. The objective is to summarize recent advances in identifying potentially useful DTI metrics in migraine patient populations. Since 2020, there has been mixed evidence regarding the applicability of various DTI metrics in migraine subpopulations. Most studies focused on whole-brain analyses, or specified regions of interest along the perivascular space, to extract quantitative parameters; most studies compared differences in these parameters associated with a migraine diagnosis, or were aiming to assess correlation between these parameters and migraine subtypes. Thus, early studies have demonstrated conflicting results regarding the utility and applicability of DTI for migraine. Greater insight into the molecular basis between migraine pathophysiology and the glymphatic system might help shape approaches to analyzing DTI data for migraine patients. Future studies incorporating larger cohorts and integrating advanced data analytics may provide additional information for the role of DTI in migraine.