Objective: Migraine is associated with white matter hyperintensities (WMH) cross-sectionally, but its effect on WMH progression is uncertain.Methods: Participants in the Atherosclerosis Risk in Communities cohort study (n 5 10,924) completed a standardized headache questionnaire between 1993 and 1995. A subset of participants (n 5 1,028) received 2 MRIs 8 to 12 years apart: once at the time of headache ascertainment, and again from 2004 to 2006. WMH were quantified using both a visually graded score (0-9) and semiautomated volumetric analysis. Linear and logistic regression models adjusted for age, sex, and other vascular risk factors were constructed.Results: Individuals who had migraine without aura were cross-sectionally associated with an 87% greater odds of having a WMH score $3 than individuals without headache (adjusted odds ratio 5 1.87; 95% confidence interval [CI]: 1.04, 3.37). Participants with migraine had an average of 2.65 cm 3 more WMH than those without headache (95% CI: 0.06, 5.24). However, there was no significant difference in WMH progression over the study period between individuals with and without migraine (1.58 cm 3 more progression for individuals with migraine compared to those without; 95% CI: 20.37, 3.53). Conclusion:Migraine is associated with WMH volume cross-sectionally but not with WMH progression over time. This suggests that the association between migraine and WMH is stable in older age and may be primarily attributable to changes occurring earlier in life, although further work is needed to confirm these findings. Several epidemiologic studies, including 2 recent population-based studies, 1,2 have demonstrated a cross-sectional association between migraine and white matter hyperintensities (WMH), a common MRI finding that is believed to represent chronic small-vessel cerebrovascular disease.3 However, these studies differ regarding the effect of sex and the presence of aura on the association between migraine and WMH. A follow-up of one of these studies found that migraine was associated with greater WMH progression, but that this was specific to women with supratentorial deep WMH. 4 To further investigate the relationship between migraine and white matter disease, we analyzed data from the Atherosclerosis Risk in Communities (ARIC) brain MRI study. We hypothesized that a history of migraine would be associated with both baseline WMH volume and WMH progression over time.METHODS Study design and participants. The ARIC study is an ongoing prospective cohort study designed to investigate the etiology of atherosclerosis and the variation in cardiovascular disease and risk factors by race and socioeconomic status.