Hypothalamic subregional volume in relation to VSS-C total symptom burden in women with migraine: an exploratory...

Dizziness, vertigo, and related autonomic symptoms are common in migraine, but whether their combined symptom-frequency burden is associated with hypothalamic subregional structure remains unclear.

This exploratory cross-sectional secondary analysis included 39 women with ICHD-3-defined migraine. All source T1-weighted images were processed uniformly with FreeSurfer 7.4.1 and automated hypothalamic subunit segmentation. Blinded quality control was performed without clinical data and independently confirmed by a neuroradiologist. The exposure was VSS-C total score, a composite of vertigo-balance and autonomic-anxiety symptom frequency. Models for five bilateral subunits and whole-hypothalamus volume adjusted for age, estimated total intracranial volume, and baseline monthly migraine days; Benjamini-Hochberg false-discovery-rate correction was applied across the six outcomes. Outcome-specific quality-control denominators were 37 or 39.

Anterior-superior hypothalamic volume was associated with VSS-C total score (n = 39; β = 0.165 mm³ per point, 95% confidence interval 0.064 to 0.266, p = 0.0021; BH-FDR-adjusted p = 0.0127). The association remained after restricting all six outcomes to the same 37 participants (BH-FDR-adjusted p = 0.0334). Across the observed 20-point VSS-C interquartile range, the coefficient corresponded to 3.31 mm³, or 8.54% of mean anterior-superior volume. DHI identified the same subregion in a separately corrected supporting analysis, but mutual adjustment attenuated both coefficients.

Higher VSS-C total symptom burden was associated with larger anterior-superior hypothalamic volume in women with migraine. This result identifies a subregional target for prospective replication with component-level symptom assessment and formal vestibular phenotyping.