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.

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).

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.