White matter lesions in migraine: a single-center retrospective study of prevalence and risk factors

Migraine is ranked as the third most common and second most disabling neurological disorder worldwide. Neuroimaging studies demonstrate higher white matter lesion (WML) prevalence in migraineurs, with a meta-analysis reporting a 44% pooled prevalence. In the UAE, migraine affects 18.2% of healthcare professionals, but WML prevalence remains unstudied. This study investigates WML prevalence and clinical correlates in UAE migraine patients.

This retrospective study included 313 migraine patients aged 10-50 years who underwent brain MRI at HMS Mirdif Hospital (2022-2025). MRI scans (3T, T2/FLAIR) were assessed by three trained doctors supervised by a radiologist. Demographic, clinical, and MRI data were collected from electronic records. Non-parametric tests and binary logistic regression were used (p < 0.05).

A total of 313 migraine patients (median age 32 years, 73.8% female) were included. White matter lesions were identified in 35.5% (n = 111), with a median of 4 lesions (IQR: 2-10). Lesions were predominantly frontal (86.5%), bilateral (70.3%), and cortical-subcortical (94.6%). Age was the only significant predictor of WML presence (OR = 1.038, p = 0.003), but did not correlate with lesion number among affected patients.

This study found white matter lesions in 35.5% of migraine patients, predominantly affecting frontal and cortical-subcortical regions. Age was the strongest predictor of lesion presence but did not correlate with lesion number. Why WMLs develop in some patients but not others remain unclear. The retrospective single-center design, potential selection bias, limited generalizability, and lack of an age- and sex-matched control group warrant cautious interpretation and underscore the need for prospective studies.