Migraine, manifesting as recurrent attacks, is a common neurovascular headache disorder accompanied by autonomic dysfunction, such as nausea, and phonophobia [1]. Epidemiological studies have shown that migraines affect nearly 15% of the general population, predominantly females [2,3]. The common clinical course of episodic migraine tends to be chronic and recurrent, especially with increasing headache frequency over time [1,4,5]. According to the Global Burden of Disease Study 2018 [6], migraine is the second leading cause of disability and affects the quality of life from occupational, academic, social, family, and personal perspectives owing to its considerable medical burden and disabling effects [7].

To avoid drug side effects [8], acupuncture, a major non-pharmacologic therapy, is recommended as a prophylactic treatment for migraines according to international guidelines [9], [10], [11]. Previous high-quality clinical trials have demonstrated that acupuncture exhibits instant and sustained effects on migraine [12], [13], [14]. However, the pathogenesis underlying migraine and the analgesic effects of acupuncture require further investigation.

Magnetic resonance imaging (MRI) is an ideal method for foundational studies of brain regions to reveal anatomic and functional alterations, particularly in multisensory integration-related brain networks [15,16]. Neuroimaging studies have confirmed that the instant or sustained efficacy of acupuncture analgesia is closely associated with functional and structural alterations in the brain [17], [18], [19]. In this study, we aimed to explore the anatomical and functional alterations of brain regions using MRI in patients with migraine compared with healthy controls to obtain meaningful clinical data and fully understand the underlying mechanisms of migraine. The voxel-based morphometry (VBM) for structural analysis and seed for functional analysis were synergistically analyzed to investigate alterations in brain gray matter (GM) volume and functional connectivity (FC) in patients with migraine. To further explore the pathogenesis of migraine, the correlation of GM volume and FC with the severity of clinical variables was explored. These findings provide the basis for understanding the pathogenesis and offer new targets for clinical treatment.

This study is divided into two parts. In the current study, we focused on addressing the neuroimaging differences between healthy controls and patients with migraines. This could help understand the pathological mechanisms by identifying migraine biomarkers. It is hypothesized that patients with migraine exhibit FC abnormalities in brain regions with morphological alterations compared to healthy controls, and that the brain areas related to these variations correlate with clinical characteristics. Based on this initial study, our future research will further explore how acupuncture alters brain structures and functions in pathological states in patients with migraines and inhibits headache.