Analysis of the relationship between the degree of migraine with right-to-left shunt and changes in white matter lesions and brain structural volume
Authors: Pan Xin , Ren Haoran , Xie Lili , Zou Yu , Li Furong , Sui Xiaowen , Cui Li , Cheng Zhengping , Wu Jiaojiao , Shi Feng , Zhao Hongling , Ma Shubei 
Published: October 2024

Objective
To investigate the location of white matter lesions (WMLs) in migraineurs with right-to-left shunt (RLS); the relationships among the severity of WMLs, changes in brain structural volume and RLS shunts; and the relationships among the severity of WMLs, changes in brain structural volume and degree of headache in RLS migraine patients.
Methods
A total of 102 migraineurs with RLS admitted to the affiliated Central Hospital of Dalian University of Technology from December 2018 to December 2022 were enrolled in this study. RLS flow and the 6-item Headache Impact Test (HIT-6) scores were recorded to reflect the degree of headache. The brain structural volumes of 102 migraineurs with RLS were calculated from T1-weighted images using artificial intelligence, and the brain structural volumes of healthy controls matched according to age and sex were also calculated. The correlations among WML location, RLS, headache degree, WML severity and brain structural volume changes in migraineurs were analysed.
Results
1. The WMLs of migraineurs with RLS were concentrated mainly in the white matter of the lateral ventricular margin and deep white matter. Subcortical WMLs were concentrated mainly in the parietal lobe, occipital lobe and frontal lobe. 2. There were no significant differences in the WML variables of cerebral white matter high signal volume, ratio of high-signal white matter volume to whole-brain white matter volume (%) or Fazekas score among migraineurs with different RLS flows, but there were significant differences in WML variables among migraineurs with RLS with different HIT-6 grades and MIDAS grades. RLS flow, HIT-6 score and MIDAS grade were not correlated with the WML variables measured in this study. 3. There was a significant difference in the volume of the precentral gyrus between migraineurs with RLS and normal controls (P < 0.001), and there was a significant difference between migraineurs with different RLS flows and different HIT-6 scores and peripheral cerebrospinal fluid volumes. There was also a positive correlation between frontal pole structural volume and RLS flow. The volume of the precentral gyrus was negatively correlated with RLS flow, whereas the volume of the pons gyrus was positively correlated with the HIT-6 score. The volume of the temporal pole was negatively correlated with the HIT-6 score.
Conclusion
1. The WMLs of migraineurs with RLS were concentrated mainly in the white matter of the lateral ventricular margin and deep white matter. Subcortical WMLs were concentrated mainly in the parietal lobe, occipital lobe and frontal lobe. 2. There was no correlation between WML severity and RLS flow in migraineurs with RLS. 3. There was no correlation between WML severity and migraine severity in migraineurs with RLS. 4. Volume changes occur in some brain structures of migraineurs with RLS. 5. Shunt flow and the degree of headache in migraineurs with RLS were correlated with structural volume changes in specific brain regions.