White matter hyperintensity burden in young patent foramen ovale patients and its correlation with migraine

Objective Patent foramen ovale (PFO) may play an important role in the progression of white matter hyperintensity (WMH) through paradoxical embolism-induced chronic cerebral microcirculatory dysfunction. WMH is closely associated with the pathogenesis of migraine. This study aims to investigate the burden of WMH in young patients with PFO and their potential association with migraine. Methods A retrospective analysis was conducted involving 47 young patients with PFO (PFO group) and 50 healthy controls (HC group). The Headache Impact Test-6 (HIT-6), Migraine Disability Assessment (MIDAS), and Visual Analogue Scale (VAS) scores were recorded to assess the severity of migraine. Conventional MRI was utilized to evaluate periventricular hyperintensity (PVH) and deep white matter hyperintensity (DWMH) grades, and the differences were compared between groups. Correlations among laboratory indicators, right-to-left shunt (RLS) grade, PFO diameter, WMH burden, and migraine severity were examined in PFO patients. Results The PVH and DWMH scores were significantly higher in the PFO group than in HC ( p < 0.001). PFO diameter and RLS grade both showed positive correlations with PVH, DWMH, VAS, MIDAS and HIT-6 scores ( p < 0.05). The grades of PVH and DWMH were significantly positively correlated with the HIT-6, VAS, and MIDAS scores ( p < 0.001). PFO diameter was an independent predictor of PVH and DWMH grades ( p < 0.001). Conclusion Young PFO patients exhibit an increased WMH burden, and PFO diameter serves as an independent risk factor for WMH grade. These findings suggest that PFO may contribute to the development of WMH in young individuals, potentially through mechanisms involving paradoxical embolism and chronic cerebral hypoperfusion. In young patients with PFO and migraine, monitoring WMH burden via neuroimaging may provide insights for future personalized management strategies.