Anterior-superior hypothalamic volume in relation to vestibular symptom burden in migraine

Abstract Background. Vestibular symptoms are common in migraine, but it remains unclear whether hypothalamic structure varies with vestibular symptom burden beyond broad diagnostic grouping. We addressed this question in an exploratory MRI study centered on continuous vestibular symptom severity within a female-predominant migraine cohort. Methods. The analytic sample comprised 41 patients with migraine and 23 healthy controls with usable 3D T1-weighted MRI. FreeSurfer 7.4.1 was used for hypothalamic subunit segmentation. Primary within-patient models regressed each of six hypothalamic outcomes on continuous Vertigo Symptom Scale (VSS) score, adjusting for age, sex, and estimated total intracranial volume, with Benjamini–Hochberg correction across the six-outcome VSS family. Questionnaire-based symptom scores were collected on the day of MRI acquisition. Results. Within the migraine cohort, anterior-superior total volume showed a positive association with VSS (β = 0.136 per VSS point, 95% CI 0.038 to 0.233, P = 0.008; FDR = 0.046). Across the typical VSS range observed in the migraine cohort (interquartile range, 13 to 34 points; 21-point span), this coefficient corresponds to approximately 2.9 mm³. Anterior-superior total volume was the only subregional outcome to survive FDR correction. Estimates were similar across robust standard-error, leave-one-out, and quadratic-age sensitivity analyses. Whole-hypothalamic associations were weaker and more model-dependent. Continuous DHI models converged on the same anatomical location but did not permit clear construct-level separation from VSS. Contextual migraine-versus-control comparisons showed no clear hypothalamic volumetric differences. Conclusions. In this exploratory cross-sectional MRI study, anterior-superior hypothalamic volume was the only subregional measure showing a preliminary association with vestibular symptom burden. Findings arise from a female-predominant migraine sample and require external validation.