Objective To investigate the association between right-to-left shunt (RLS) and white matter lesions (WML) in patients with migraine.Methods The patients with migraine who attended the outpatient service of Beijing Tiantan Hospital from July 2014 to February 2017 and met the International Classification of Headache Disorders (ICHD) criteria were enrolled, and related data including baseline data and clinical features were collected. All patients underwent transcranial Doppler (TCD) foaming test and magnetic resonance imaging (MRI). RLS was defined as at least one embolus signal in bilateral middle cerebral arteries on TCD foaming test, and WMLs were identified as hyperintense lesions on both T2-weighted and FLAIR imaging of deep or subcortical white matter. The severity of WMLs was evaluated based on the Fazekas scale.Results A total of 254 patients were enrolled, among whom 57.1% were female. Of all patients, 143 (56.3%) had RLS and 149 (58.7%) had WMLs. Compared with the WMLs-negative group with 105 patients, the WMLs-positive group with 149 patients had a significantly higher proportion of patients with RLS (69.1% vs 38.1%, P<0.05).Conclusions WMLs may be associated with RLS in patients with migraine.