Migraine Headaches Tied to Dry Eye Disease

By Marilynn Larkin

NEW YORK (Reuters Health) - People who have migraine headaches have higher rates of comorbid dry eye disease (DED), researchers say.

"Migraine headaches and DED are driven by underlying inflammatory processes," Omar Ismail of the University of North Carolina, Chapel Hill told Reuters Health by email. "Both disorders may share a common inflammatory component that makes the presence of DED more likely in patients with a history of migraines."

"Furthermore, the trigeminal ganglion also plays an important role in the pathogenesis of both DED and migraine headaches," he noted. "It is possible that this structure could account for the potential relationship between the two disorders."

Ismail and colleagues analyzed data collected from 2008 to 2018 on close to 73,000 adults treated at University of North Carolina-affiliated healthcare facilities (57% men; 58% white; 22% African American).

As reported March 7 online in JAMA Ophthalmology, 5,352 (7.3%) were diagnosed with migraine headache and 9,638 (13.2%) were diagnosed with DED.

For those with migraine headaches, the unadjusted odds of having DED were 1.72 times higher than for patients without migraine headaches. After adjustment for multiple confounders, the odds were 1.42 times higher.

Further adjusted analyses showed that patients age 65 and older had odds ratios that suggested an association between migraine headaches and DED: OR, 1.96 for men and 2.47 for women.

However, the authors note, the association between the two conditions may not reflect cause and effect if unidentified confounders account for the results.

Nonetheless, "Physicians caring for patients with a history of migraines should make sure to question these individuals about whether they experience ocular symptoms commonly associated with DED, such as dryness, burning, a sensation of grittiness," Ismail said. "Patients suffering from such symptoms may benefit from referral to an ophthalmologist."

Dr. Viral Juthani, attending physician, Ophthalmology and Visual Sciences at Montefiore Health System in New York City, commented by email, "The association between DED and migraine headaches has been studied previously, however mostly in smaller cohorts, and results have conflicted to some degree."

"The value of this study is in the size and reasonable diversity of the patient population in the United States," he said. "The limitations of the study include the restriction of data collection to the Carolina Data Warehouse for Health. In addition, no specific criteria for the diagnosis of DED (subjective or objective) could be used due to the nature of the data collection."

Like Ismail, he noted, "Based on the strength of the association found, patients with migraine headaches seen in primary care or neurology clinics should be referred to an eye care professional to be screened for DED, especially those with ocular symptoms."

"Ophthalmologists should also consider migraine headaches as a potential contributor to eye pain in the setting of DED," he added.

"In the near term however, cause and effect between the two conditions would be difficult to prove, given unidentified confounders," Dr. Juthani said said. "An interesting next question would be if the treatment of dry eye disease reduces the frequency or severity of migraine headaches in patients with both conditions. This has not yet been answered sufficiently and further study is needed."

SOURCE: https://bit.ly/2Cim3fd

JAMA Ophthalmol 2019.

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