Migraine Tied to Increased Risk for Dry Eye Disease

Diana Phillips

March 12, 2019

Patients who experience migraine are more likely than the general population to also have dry eye disease (DED), a study has shown. And although the exact mechanism underlying the relationship between the two conditions is not clear, they share certain underlying inflammatory processes that may explain the connection, the researchers hypothesize.

Previous research has suggested an association between DED and migraine, but the findings to date have not been consistent nor conclusive, Omar M. Ismail of the Department of Ophthalmology at the University of North Carolina, Chapel Hill, and colleagues report in an article published online March 7 in JAMA Ophthalmology.

The current investigation — a retrospective, population-based study — was designed to establish the strength of the association between the tear film disorder and migraine headaches.

The researchers identified 72,969 adults seen at one of the university’s ophthalmology clinics from May 1, 2008, through May 31, 2018. Of those, 5352 (7.3%) were diagnosed with migraine and 9638 (13.2%) had DED. After adjusting for patient age group and sex and excluding patients with confounding factors related to eye dryness (eg, certain medications, autoimmune diseases, and surgical procedures), the odds of having DED given a diagnosis of migraine was 1.42 (95% confidence interval [CI], 1.20 - 1.68) times higher than that of patients without migraine.

Female sex and advancing age also appear to influence the strength of the association. Before adjusting for confounding factors, a statistically significant association was observed across women in all age groups, and after adjustment, significant associations between DED and migraine were observed in patients aged 65 years or older for both men (odds ratio [OR], 1.96; 95% CI, 1.02 - 3.77) and women (OR, 2.47; 95% CI, 1.75 - 3.47).

The increasing strength of the association with advancing age is consistent with previous research, the authors write. "Advanced age and female sex are both risk factors for the development of DED resulting from hormonal and age-related changes." Furthermore, before accounting for confounding variables, the statistically significant association across women of all age groups is not surprising given the increased incidence of migraine in women, they note.

Inflammatory processes play a role in both migraine and DED, which may explain the association between the two, the authors explain. For example, migraine has been linked to increased levels of C-reactive protein and interleukin-10, as well as to a cascade of events triggered by neurogenic inflammatory mediators.

T-lymphocyte mediated inflammatory changes in DED "might trigger similar events in neurovascular tissue, leading to the development and propagation of migraine headaches, or vice versa," the authors write. Trigeminal ganglion activity might also be a shared mechanism.

Despite limitations of the study related to its retrospective design, the findings support an association between migraine and DED. "Our results suggest that female sex and advanced age play an important role in determining the strength of this association," the authors conclude. "Physicians caring for patients with a history of migraine headaches should be aware that these patients may be at risk for comorbid DED."

The authors have disclosed no relevant financial relationships.

JAMA Ophth. Published Online March 7, 2019. Abstract

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