Elevated risk of dry eye disease in individuals with migraine
A recent study from the US has suggested an increased likelihood of dry eye disease among individuals diagnosed with migraines.
Researchers of this retrospective case-control study used data of 72,969 adults (57.2 percent male) who attended healthcare ophthalmology clinics of the University of North Carolina (UNC), US, between May 2008 and May 2018 to identify 5,352 patients (7.3 percent) who had been diagnosed with migraines and 9,638 patients (13.2 percent) who been diagnosed with dry eye disease. The majority of patients were aged ≥65 years (37.4 percent), followed by age 35–54 years (24.2 percent).
After adjusting for age and sex, patients with migraine headaches were 1.72 times more likely to have dry eye disease than those without migraine headaches (odds ratio [OR], 1.72, 95 percent confidence interval [CI], 1.60–1.85). [JAMA Ophthalmol 2019;doi:10.1001/jamaophthalmol.2019.0170]
The increased risk of dry eye disease among patients with migraine compared with those without persisted even after excluding patients with confounding factors for dry eye disease such as a history of rheumatoid arthritis, lupus, Sjögren syndrome, cataract, or refractive surgery, and use of medications such as antihistamines, tricyclic antidepressants, or diuretics (OR, 1.42, 95 percent CI, 1.20–1.68 in a population of 39,306 patients).
This association was particularly evident among women and men aged ≥65 years (OR, 2.47, 95 percent CI, 1.75–3.47 and OR, 1.96, 95 percent CI, 1.02–3.77, respectively).
While the mechanism behind the association between dry eye disease and migraine is unknown, inflammatory processes that are involved in the pathogenesis of both conditions may play a role, said the researchers.
“Inflammatory changes in dry eye disease might … [lead] to the development and propagation of migraine headaches, or vice versa. Furthermore, excessive dryness of the ocular surface can trigger reflex tearing via the trigeminal nerve, which could subsequently trigger auras and acute migraine attacks, given the role of the trigeminal ganglion in the pathophysiology of migraine headaches,” they said.
As for the association in women aged ≥65 years, “hormonal and age-related changes” may be responsible for the development of dry eye disease, and migraines occur more frequently in women than men, though the prevalence reduces with age in both sexes, they added.
The researchers acknowledged that the results may not extend to the general population as the study cohort comprised patients presenting at UNC-affiliated clinics only.
“[T]he results of this study suggest a link between migraine headaches and dry eye disease … and that female sex and advanced age play an important role in determining the strength of this association,” they concluded, calling on physicians to be aware of the potential likelihood of dry eye disease in their patients who have a history of migraines.