Inflammatory and atherogenic markers linked to white matter hyperintensities in migraine without traditional vascular risk factors.

OBJECTIVE: White matter hyperintensities (WMH) are common on magnetic resonance imaging in migraine, but their mechanisms remain unclear. We examined associations of systemic inflammatory and atherogenic indices with WMH burden in migraine without major vascular risk factors. METHODS: This retrospective case-control study included 320 participants: migraine with Fazekas grade 0 (n = 112), migraine with Fazekas grades 1-3 (n = 118), and healthy controls (n = 90). C-reactive protein (CRP), systemic immune-inflammation index (SII), atherogenic index of plasma (AIP), and total cholesterol/high-density lipoprotein cholesterol (TC/HDL-C) ratio were analyzed. Current smoking, current alcohol use, DSM-5 alcohol use disorder, and body mass index (BMI) ≥ 30 kg/m2 were exclusion criteria. RESULTS: Age and sex distributions were similar across groups. CRP was higher in migraine patients with Fazekas grades 1-3 than in those with Fazekas 0 and controls (p < 0.001). The TC/HDL-C ratio was elevated in the Fazekas 1-3 group compared with both comparison groups (p < 0.001). AIP was also higher with WMH (p = 0.001), whereas SII did not differ. Fazekas grade correlated with disease duration, monthly headache days, and TC/HDL-C ratio (all p < 0.001). In multivariable analysis, disease duration, monthly headache days, CRP, and TC/HDL-C ratio were independently associated with WMH presence. CONCLUSIONS: Among migraine patients without major vascular risk factors, WMH were associated with greater disease chronicity and increased inflammatory and atherogenic indices, supporting an inflammation-related vascular hypothesis. Their clinical significance remains uncertain. Prospective studies should determine whether effective migraine prophylaxis modifies these markers or WMH incidence and progression.