Association Between Small Vessel Disease and Migraine: A Study Based on Peak Width of Skeletonized Mean Diffusivity

Migraine is a common neurological disorder associated with structural and functional brain changes, while small vessel disease (SVD) is the leading cause of white matter damage in older adults. Diffusion tensor imaging (DTI) is effective for assessing white matter, and the peak width of skeletonized mean diffusivity (PSMD) is a novel marker for such damage. No study has used PSMD to assess SVD in migraine patients. This study aimed to investigate the relationship between migraine and SVD using PSMD.

Seventy-three migraine patients and 73 healthy controls underwent brain DTI to calculate PSMD. Clinical data on migraine characteristics were collected. We compared PSMD values between groups and analyzed correlations with clinical factors in patients with migraine.

Patients with migraine had a significantly higher PSMD than healthy controls (2.08×10⁻⁴ mm²/s vs. 2.04×10⁻⁴ mm²/s, p=0.027), indicating increased white matter damage due to SVD. However, there was no difference in the PSMD between men and women with migraine. No significant differences in the PSMD were found between patients with migraine with and without aura (2.14×10⁻⁴ mm²/s vs. 2.07×10⁻⁴ mm²/s, p=0.074). A positive correlation existed between the PSMD and disease duration in men with migraine (r=0.601, p=0.006). Sex differences were evident, with men having a higher prevalence of aura and with women having a greater headache intensity (47.3% vs. 12.9%, p=0.002; 6.0 vs. 8.0, p=0.025).

Our findings indicate a potential association between migraine and SVD, with PSMD serving as a useful MRI marker for assessing white matter damage in headache disorders.