Hypothalamic subregional perfusion alterations in migraine: a 3D-PCASL study

Migraine is a common neurological disorder with hypothalamic involvement, yet cerebral blood flow (CBF) and volume changes in specific hypothalamic subregions remain unclear. This study used three-dimensional pseudo-continuous arterial spin labeling (3D-PCASL) to investigate perfusion and volume differences among episodic migraine (EM), chronic migraine (CM), and normal control (NCs) groups.

Forty-three participants underwent 3.0T MRI scanning. The hypothalamus was segmented into 10 subregions using FreeSurfer, and volume and CBF values were extracted. A general linear model adjusted for age and total intracranial volume (TIV) assessed intergroup differences. ROC curve analysis and correlation analysis were performed to evaluated clinical significance.

No significant hypothalamic subregional volumetric differences were found. Compared with NCs, the EM group had significantly lower CBF in the left anterior inferior subregion, whereas the CM group had significantly lower CBF in the right anterior superior subregion, right tubular superior subregion, and whole right hypothalamus. The AUC of left anterior inferior CBF for discriminating migraine patients from NCs was 0.717. Right hypothalamic subregional CBF showed relatively high specificity for distinguishing CM from NCs. In the EM group, CBF in the left anterior inferior subregion was positively correlated with MMSE scores at the uncorrected level (Spearman's rho = 0.565, uncorrected p = 0.028).

Migraine patients exhibit specific hypothalamic subregional perfusion abnormalities without macroscopic volumetric changes. Left anterior inferior hypoperfusion may represent a preliminary imaging marker of migraine, whereas right-sided hypothalamic perfusion alterations may be associated with CM. The association between hypothalamic perfusion and cognitive function requires validation in larger samples.