Background:White matter hyperintensities (WMHs) on MRI have been increasingly reported in migraine patients, but their association with specific migraine patterns—such as chronicity, frequency, and aura—remains incompletely understood. This study aimed to evaluate the relationship between migraine subtypes and the prevalence, distribution, and severity of WMHs using MRI brain imaging.

Methods:This cross-sectional observational study included 93 adult migraine patients (aged 18–55 years) diagnosed according to the International Classification of Headache Disorders, 3rd edition (ICHD-3). Participants were categorized into migraine with aura (MA, n=28) and without aura (MO, n=65), and into chronic (n=27) and episodic (n=66) migraine groups. All subjects underwent 1.5T MRI brain scans. WMHs were evaluated using T2-FLAIR sequences and graded using the Fazekas scale. Clinical and demographic data were collected and analyzed. Associations were assessed using chi-square tests, t-tests, Spearman’s correlation, and multivariate logistic regression.

Results:WMHs were observed in 38 patients (40.9%). Their prevalence was significantly higher in MA (57.1%) compared to MO (33.8%) (p=0.031), and in chronic migraine (66.7%) compared to episodic migraine (30.3%) (p=0.001). Deep white matter and bilateral WMHs were more frequently seen in chronic migraine patients. Fazekas scores were significantly higher in MA (1.32 ± 0.89) and chronic migraine groups (1.48 ± 0.62). Spearman’s correlation showed significant positive associations between WMH severity and duration of illness (ρ=0.382, p=0.001), frequency of attacks (ρ=0.415, p<0.001), and duration of episodes (ρ=0.336, p=0.004). Multivariate analysis identified chronic migraine (OR: 3.39, p=0.012), ≥5 years duration (OR: 2.87, p=0.021), and ≥4 attacks/month (OR: 3.14, p=0.014) as independent predictors of WMHs.

Conclusion:The presence and burden of WMHs are significantly associated with migraine chronicity, attack frequency, and aura status. These findings suggest that higher migraine burden may contribute to structural brain changes and underscore the importance of early and sustained migraine control to prevent potential long-term neurovascular consequences.