November 2007

 

OPHTHALMOLOGY NEWS

 

Migraine history in middle-aged patients


by Maxine Lipner Senior EyeWorld Contributing Editor

 

 

New study results show a connection between headaches and vision problems

A history of migraine for middle-aged patients may carry with it more than just substantial discomfort. Such patients are also significantly more likely to have retinopathy than those who don’t suffer from such headaches, new study results published in a recent issue of Neurology indicate. Investigators thought there might be a connection between vascular headaches and retinal microvascular disease based on previous efforts. “There is literature on migraines and cardiovascular diseases, and we had done some earlier work on migraines, coronary disease, and strokes,” said Kathryn M. Rose, Ph.D., research assistant professor, University of North Carolina, Chapel Hill, School of Public Health, Chapel Hill, N.C. “This led us to be interested in looking at retinopathy because it’s a microvascular disease,”

Circulatory connection

History has shown that retinopathy patients are at greater risk for coronary events. “People with retinopathy are more likely to have strokes,” Dr. Rose said. “Known causes of retinopathy are hypertension and diabetes particularly.”

The investigation was an offshoot of the large Arteriosclerosis Risk in Community (ARIC) study initiated in 1987. The ARIC study included middle-aged patients between the ages of 45 to 64 years at baseline from four communities: Washington County, Md.; Jackson, Miss.; Forsyth, N.C.; and the Northwest suburbs of Minneapolis, according to Dr. Rose. “Ascertainment of headache history and the retinal examination did not occur until the third ARIC visit, which was in 1993 to 1995,” she said. Of the original ARIC participants, 22% had a history of migraine or other headache. At the time of the examination, patients were between 51 and 71 years of age.

Aura association

Investigators found a correlation between those who had retinopathy and headache sufferers. “Our results show that people with headaches were more likely to have retinopathy,” Dr. Rose said. “It was a modest association.” Results showed that sufferers of migraines and other headaches were between 1.3 and 1.5 times more likely to have retinopathy than those without headaches. Patients who had aura symptoms during their headache bouts were most prone to retinopathy. Those who had migraines or other headaches with auras were 1.49 times more likely to have retinopathy, while those who had migraines or headaches without auras were just 1.28 times as likely to be plagued by the condition. “There’s not a lot of studies on migraines and retinopathy, so these aren’t definitive findings, but they point to the potential importance of aura,” Dr. Rose said. Even when factors such as diabetes, glucose levels, cigarette smoking, blood pressure, and blood pressure medications were taken into account, the association persisted.

These results became even more compelling when investigators narrowed their focus a bit. “What was somewhat interesting is that there were about 11,000 participants included in that analysis,” Dr. Rose said. “When we examined the subset of participants that did not have diabetes and did not have hypertension, two major risk factors for retinopathy, we found that the associations were stronger for migraine and other headaches that included aura symptoms.” In this subset, patients with a history of headaches with auras were 1.79 times as likely to have retinopathy, and those with headaches without auras were 1.74 times as likely to have the condition. “That’s similar to what we found in an earlier study for angina or chest pain and also for stroke,” Dr. Rose said. Investigators concluded that retinopathy signs were more likely to be manifested by middle-aged people who suffered from migraines and other headaches. Dr. Rose theorized that the connection between migraines and retinopathy might be small blood vessels or problems in the circulatory system. “Both headaches and retinopathy involve small vessels or microcirculation,” Dr. Rose said. “It seems that there might be some dysfunction in the microvasculature system that is causing both conditions.” Dr. Rose thinks that the patient’s age may also come into play. “Migraine manifests early in life, and retinopathy tends to happen when people are older,” she said.

Further studies need to be done on this, Dr. Rose believes. “I think that given this hasn’t been reported [before] and that our findings weren’t strong that it’s important that this kind of work be replicated,” she said. However, the study does help to bring forward what might be at the root of migraines. “There is a lack of consensus in the literature on the underlying causes of migraine.” Dr. Rose said. “So, to me, this provides additional evidence of the contribution of a vascular component.”

Contact Information

Rose: 919-962-2211, Kathryn_rose@unc.edu

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