OC-12 | The potential role of sleep quality in the relationship between glymphatic function and migraine frequency: insights from a cross-sectional study

Background: Migraine has a complex pathophysiology involving genetic predispositions, comorbidities, and psychosocial factors. Emerging evidence highlights the glymphatic system – responsible for brain waste clearance – as a potential contributor to migraine pathogenesis. As poor sleep quality exacerbates glymphatic dysfunction, it might have an impact on migraine chronification. Methods: This cross-sectional study included 106 individuals with migraine (80.2% female; median age: 45.0 years, IQR = 37.0–52.0) between June 2018 and February 2020. Glymphatic function was assessed using the DTI-ALPS index derived from brain magnetic resonance imaging, while sleep quality was evaluated with the Pittsburgh Sleep Quality Index. First, we evaluated the association between DTI-ALPS index and monthly headache days. A second model included the dichotomized Pittsburgh Sleep Quality Index score (“poor” vs. “good” sleepers) and its interaction with the DTI-ALPS index to examine the moderating role of sleep quality in the relationship between glymphatic function and monthly headache days. Results: Higher DTI-ALPS index values were associated with fewer monthly headache days in the overall sample while controlling for age and sex [adjusted IRR = 0.37, 95% CI = 0.16 – 0.86, p = 0.020]. Additionally, there was a significant interaction between DTI-ALPS index and sleep quality [adjusted IRR = 0.13, 95% CI = 0.02 – 0.76, p = 0.024] in predicting monthly headache days. We found an association between lower DTI-ALPS and higher headache days only in participants with poor sleep quality [adjusted IRR = 0.21, 95% CI = 0.08 – 0.59, p = 0.003] whereas no association was found in good sleepers [adjusted IRR = 1.66, 95% CI = 0.38 – 7.16, p = 0.500]. Results remained consistent after adjusting for clinical variables such as disease duration, medication overuse, cutaneous allodynia, aura status, and migraine subtype. Conclusion: Poor sleep quality moderates the association between glymphatic dysfunction and monthly headache days. The results highlight the potential importance of sleep interventions in managing migraine and improving brain glymphatic function.