Migraine may increase risk for retinal artery occlusion
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Migraine was associated with increased risk for retinal artery occlusion, with a higher risk in migraine with aura, according to a retrospective cohort study in American Journal of Ophthalmology.
“Because migraine increases the risk of ischemic stroke, it is reasonable to hypothesize that migraine also increases the risk of RAO,” Ahmad Al-Moujahed, MD, PhD, MPH, of the department of ophthalmology at Stanford University, and colleagues wrote. “In fact, several reports have described cases of different subtypes of unilateral and bilateral RAO, including hemi-RAO, BRAO, cilio-RAO and CRAO, in patients with migraine either during or between attacks, which were clearly different from the common temporary visual symptoms in these patients and with negative workup for the common causes of RAO. However, to date, no study has assessed whether migraine is associated with an increased risk of RAO.”
The study included 418,965 patients (81.1% women) with two migraine diagnoses within 1 year of each other and at least 2 years of continuous enrollment in the IBM MarketScan Commercial Claims and Encounters database. Patients were matched with control subjects based on age, database enrollment year and sex. The researchers recorded whether patients had a history of comorbidities and diseases associated with retinal artery occlusion (RAO) and controlled for triptan prescription and pregnancy.
Patients were diagnosed with migraine at a mean age of 41.2 years and with RAO at a mean age of 50 years. In the control group, RAO was diagnosed at a mean age of 52 years, while in the migraine group, RAO was diagnosed at a mean age of 49 years. Patients with migraine were more likely to have comorbidities and diseases related to RAO.
RAO risk was higher in the migraine cohort than the control cohort (P < .0001). The risk association was consistent for central RAO (CRAO) (P = .004), branch RAO (BRAO) (P < .001) and transient and partial RAO (P < .001).
RAO risk was higher in patients with migraine with aura than without aura (P < .001), which was consistent for BRAO (P < .03) and transient and partial RAO (P < .001).
RAO was significantly associated with older age, male sex, acute coronary syndrome, valvular disease, carotid disease, hyperlipidemia, hypertension, retinal vasculitis or inflammation, and systemic lupus erythematosus, according to the study.
Study limitations included potential coding and billing errors, lack of visual acuity data, the low number of patients using triptan, the nature of the database and the lack of analysis of specific causes of increased RAO risk.
“This is the first study of its kind, and therefore it is necessary to validate these findings in a separate dataset to establish the association more conclusively,” Al-Moujahed and colleagues wrote.
Perspective
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RAO is a rare entity attributed to an acute obstruction of the retinal arteries resulting in painless, acute vision loss. RAO has been compared to a cerebral infarction or ischemic stroke of the brain as it is also caused by a localized disruption in blood flow. It has been documented that patients with migraine have an increased risk for ischemic stroke and thus may be at increased risk for RAO. The authors of this study sought to determine if in fact there is a correlation between migraine and the development of RAO.
The study concluded that there is a correlation between the two entities, and that migraine with aura is associated with an increased risk for RAO compared with migraine in the absence of aura. Stated risk increases in older, male patients and patients with heart disease, carotid disease, hypercholesterolemia, hypertension or systemic/retinal inflammation. Additional studies are needed to assess the functional outcomes of patients and the role of migraine management and treatment in the development of RAO. Optometrists must be aware of the association between these entities and comanage these cases with neurology.
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