Association between migraine and cerebral white matter hyperintensities in middle‐aged and older individuals: A cross‐sectional study using the UK Biobank cohort

OBJECTIVE: This study aimed to explore the association between migraine and white matter hyperintensities (WMHs) in middle-aged and older individuals from the UK Biobank cohort. BACKGROUND: The evidence linking migraine to brain WMHs remains inconsistent. METHODS: This cross-sectional study included 3431 individuals with migraine and 26,969 individuals without headache disorders. Most migraine diagnoses were based on self-reported data. The volume of WMHs was primarily derived from T2 fluid-attenuated inversion recovery images, in combination with T1 data, using an automatic segmentation tool. We compared the burden of WMHs between individuals with migraine and those without migraine or any other headache syndromes. RESULTS: The mean (standard deviation; range) age at the time of imaging was 64.3 (7.7; 45-82) years. There were 15,875 female participants and 14,525 male participants. Multivariable linear regression analyses, adjusted for all covariates, showed that migraine overall was significantly associated with a reduced total WMHs burden (β = -0.05, 95% confidence interval [CI] -0.08 to -0.02; p = 0.002) and a reduced periventricular WMHs burden (β = -0.05, 95% CI -0.08 to -0.02; p = 0.001). Migraine overall was not significantly associated with deep WMHs burden (β = -0.05, 95% CI -0.09 to 0.01; p = 0.052). Sensitivity analyses yielded consistent results. In subgroup analyses, migraine was significantly associated with decreased total WMHs burden, deep WMHs burden, and periventricular WMHs burden in individuals aged <65 years, but no significant association was observed in those aged ≥65 years (all p for interaction <0.05). In sex-stratified analyses, no significant interaction effect was found. CONCLUSION: In middle-aged and older individuals, migraine overall is associated with a decreased WMHs burden. Future research should focus on exploring the mechanisms underlying this association and examining the relationship between specific migraine subtypes and WMHs burden.