2026 American Academy of Neurology Abstract Website

Objective:

To examine associations between cortical morphometry and clinical parameters in patients with migraine using whole-brain FreeSurfer-derived measures and standardized assessments.

Background:

Migraine is a prevalent neurological disorder. Although cortical alterations have been reported, their relationship with clinical manifestations such as pain, disability, psychiatric comorbidity, and sensory symptoms remains unclear.

Design/Methods:

We analyzed 112 migraine patients with clinical measures including Visual Analog Scale, Headache Impact Test-6 (HIT-6), Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7, and Allodynia Symptom Checklist-12. Binary indicators were assigned for nausea, vomiting, phonophobia, photophobia, and osmophobia. Cortical thickness, surface area, and gray matter volume from 68 regions were extracted with FreeSurfer. Continuous variables were z-standardized and entered into ROI-wise linear regression models, adjusting for age, sex, migraine type, global brain measures, and symptom indicators. False discovery rate correction was applied within each predictor-metric domain

Results:

Significant associations (q<0.05) were observed between cortical structure and clinical measures. Age showed the strongest effects: greater age correlated with reduced thickness in the lateral orbitofrontal, paracentral, caudal middle frontal, and transverse temporal cortices, and with increased surface area in bilateral insula, orbitofrontal, entorhinal, and frontal pole regions, as well as increased fusiform and temporal pole thickness. HIT-6 was positively related to thickness in the isthmus cingulate, rostral anterior cingulate, transverse temporal cortex, and precuneus, but negatively to caudal middle frontal thickness. Higher PHQ-9 scores were linked to reduced temporal pole thickness. Phonophobia was associated with reduced gray matter volume in the right precuneus. Model fit was moderate to high (R² = 0.22–0.83).

Conclusions:

Cortical morphology in migraine patients is significantly influenced by age, symptom burden, and psychiatric comorbidity. Our integrated approach—combining dimensional and categorical analyses—highlights structural correlates of clinical heterogeneity in migraine and may inform future patient stratification and treatment strategies.