The Role of the Amygdala in Impaired Interoceptive Accuracy Awareness in Migraine: A Resting-State Functional Connectivity Study

Background The notion that migraine is characterized by compromised allostatic interoception is gaining acceptance. While the dorsal amygdala (dAmy) may play a crucial node in this allostatic interoceptive process, with lesion studies providing evidence for its role in interoceptive accuracy awareness, the exact neural mechanisms linking dAmy dysfunction to migraine are still unclear. This study aimed to evaluate interoceptive changes in migraine and to clarify the role of amygdala dysfunction in allostatic interoceptive disruptions in migraine. Methods Twenty-nine migraine patients without aura and thirty-two age- and sex-matched healthy controls (HC) underwent behavioral assessments of interoception and resting-state functional magnetic resonance imaging (fMRI). A multivariate seed-based connectivity analysis was performed to explore the whole-brain effective connection patterns of the right dAmy and its association with interoceptive accuracy awareness. Furthermore, mediation analysis was used to examine whether the group differences (migraine vs. control) in interoceptive accuracy awareness were explained by direct amygdala connection. Results Migraineurs exhibited noticeably greater interoceptive accuracy awareness compared to HC, indicating a tendency to overestimate their interoceptive abilities. A significant negative correlation was observed between this awareness and effective connectivity from the right dAmy to the right superior parietal lobule (R_SPL), which remained significant across the entire sample. The direct connection between the dAmy–R_SPL was notably diminished in migraineurs. Mediation analysis confirmed that this connectivity strongly accounted for the group difference in interoceptive awareness. Additionally, migraineurs showed a trend toward increased direct connectivity between the right dAmy and areas of the default mode network, including the lateral occipital cortex and precuneus. Conclusions This study provides the first mechanistic evidence that a weakened dAmy–R_SPL pathway mediates interoceptive miscalibration in migraine, positioning amygdala-centered networks as a key substrate of disrupted allostatic interoception and migraine pathophysiology.