Dry eye seems to be the most important symptom that reduces visual quality of life (QoL) and worsens headache impact in patients who experience migraines. That finding emerged from a cross-sectional study conducted at the University of Utah in Salt Lake City.1
“We knew from previous research that patients with chronic migraine have reductions in visual QoL that can be as substantial as those reported for neuro-ophthalmic diseases such as multiple sclerosis with optic neuritis and idiopathic intracranial hypertension,” said neurologist Seniha Ozudogru, MD. Coauthor and neuro-ophthalmologist Kathleen B. Digre, MD, added, “The purpose of this investigation was to attempt to determine which ocular symptom(s) were driving the observed reductions in visual QoL.”
Methods. Patients were recruited from the Headache Clinic and General Neurology Clinic in Salt Lake City. They completed several validated questionnaires, including the NEI visual functioning questionnaire-25 (VFQ-25), the headache impact test (HIT-6), the visual aura rating scale (VARS), the ocular surface disease index (OSDI), and the Utah photophobia symptom impact scale (UPSIS-17).
Results. Of the 62 patients who completed all questionnaires, 17 had episodic migraine and 45 had chronic migraine. Twenty-three patients experienced aura.
The most striking correlations were observed between VFQ-25 and the OSDI (‒0.678; p < .001), between the HIT-6 and UPSIS-17 (0.489: p < .001), and between the HIT-6 and OSDI (0.453; p < .001). The strongest of these correlations was between VFQ-25 and OSDI, indicating that as symptoms of dry eye increase, visual QoL also worsens.
Among the ocular symptoms tested, dry eye seemed to be the only symptom that correlated with reductions in visual QoL in migraine patients. Also, the statistically significant correlation between HIT-6 and OSDI supports the researchers’ hypothesis that dry eye symptoms may be both a significant and underappreciated problem for migraine patients. Photophobia had a modest influence on headache impact.
A form of allodynia? The researchers speculated that dry eye symptoms in migraine may be a form of allodynia, pain from usually painless stimulation, a well-known feature of chronic migraine. Their hope is that future investigations will help determine if dry eye treatments are helpful—and, if so, will pinpoint those treatments that are the most effective.
1 Ozudogru S et al. Headache. 2019;59(10);1714-1721.
Relevant financial disclosures—Drs. Digre and Ozudogru: None.
For full disclosures and the disclosure key, see below.
Full Financial Disclosures
Dr. Bharti None.
Dr. Binenbaum Luminopia: C,O; NEI: S; Natus Medical: L; X Biomedical: O,P.
Dr. Digre None.
Dr. Ozudogru None.
Dr. Yoon Alcon: C,L; Allergan: C,L,S; Bayer Pharmaceuticals: C,L,S; Boehringer Ingelheim: C.
||Consultant fee, paid advisory boards, or fees for attending a meeting.
||Employed by a commercial company.
||Lecture fees or honoraria, travel fees or reimbursements when speaking at the invitation of a commercial company.
||Equity ownership/stock options in publicly or privately traded firms, excluding mutual funds.
||Patents and/or royalties for intellectual property.
||Grant support or other financial support to the investigator from all sources, including research support from government agencies (e.g., NIH), foundations, device manufacturers, and/or pharmaceutical companies.
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