Altered cortical myelin and thickness in migraine patients with patent foramen ovale: A novel surface-based analysis.

An association between migraine and patent foramen ovale (PFO) has been reported; however, the precise nature of this connection remains unclear. This study aimed to further identify and parse the structural alterations in migraine patients with PFO, providing new insights into the interplay between PFO and migraine. We examined cortical myelin and thickness in 110 female patients with migraine (60 with PFO, 50 without) and 50 healthy controls (25 with and without PFO). The main effects of migraine and PFO, as well as their interaction, were analyzed with a general linear model with age as a covariate for two-way analysis of variance. We observed that individuals with PFO presented a broad and diffuse increase in cortical thickness and changes in the strength of the myelin-sensitive contrast within the cortex. Furthermore, we found a specific region in the right inferior parietal cortex that exhibited PFO-related reductions in intracortical myelin, with a significant migraine-PFO interaction (cluster size (Vertices) = 133, p < 0.05). The headache impact test score was negatively correlated with the myelin index in this region (r = -0.396, p < 0.0001). This study revealed structural brain changes in migraine patients with PFO, indicating that myelin mapping may serve as a potential biomarker for identifying these alterations. This approach could help differentiate migraine patients with PFO, supporting targeted therapies. Combining myelin mapping with diffusion imaging may further improve the detection and monitoring of structural changes, enhancing diagnostic and treatment strategies.