ConexiantMRI May Define Two Distinct Migraine Phenotypes

⚠️ Small Study / Early Comparative Evidence

Migraine is clinically heterogeneous, but imaging-based subtyping remains investigational. This study applied principal component analysis and hierarchical clustering to structural and resting-state functional MRI data from 111 patients with migraine and 51 controls, identifying two multimodal imaging-derived phenotypes with differing functional connectivity and cortical volume profiles.

Clinical Considerations:

• The higher-burden cluster (M2f+s) showed increased connectivity across dorsal attention, somatomotor, and visual networks with thalamic, basal ganglia, hippocampal, and amygdalar involvement
• M2f+s patients had greater migraine-related disability, longer duration, higher medication overuse headache rates, and lower pain self-efficacy despite comparable headache frequency and intensity to the lower-burden cluster
• Lower cortical volumes in frontal, parietal, temporal, and insular regions characterized M2f+s; structural-only clustering showed minimal overlap with the multimodal solution
• Functional connectivity contributed substantially to subgroup differentiation; structural variation appeared to capture an orthogonal dimension of heterogeneity

Practice Applications:

• Recognize that migraine burden and disability may not correlate with headache frequency alone
• Consider that neuroimaging heterogeneity may eventually inform patient stratification for prevention trials
• Interpret findings as hypothesis-generating; imaging-based phenotyping is not yet a clinical tool
• Monitor this line of research as multimodal MRI approaches mature toward larger longitudinal validation