Migraine tied to higher risk for open-angle glaucoma onset among South Korean adults
Key takeaways:
- Patients with migraine aged younger than 40 years had higher risk for open-angle glaucoma onset vs. those aged 40 years or older.
- The presence of aura did not affect the risk for developing open-angle glaucoma.
A history of migraine, with or without aura, was a significant risk factor for open-angle glaucoma onset among a cohort of South Korean adults, according to a study published in the Journal of Glaucoma.
“Several studies have recently shown that migraine may have a close association with neurovascular disease,” Hyung Jun Kim, MD, of the department of neurology at Samsung Medical Center and Sungkyunkwan University School of Medicine in Seoul, South Korea, and colleagues wrote. “Endothelial dysfunction has been identified as a migraine-related phenomenon that shares possible risk factors with open-angle glaucoma.”
They continued, “However, previous large-scale studies have shown contradictory results regarding the association between migraine and open-angle glaucoma, leaving room for debate concerning whether migraine is a true risk factor for open-angle glaucoma onset.”
To examine the association between open-angle glaucoma and migraine, Kim and colleagues conducted a retrospective cohort study using data from 1,103,302 South Korean individuals in the Korean National Health Insurance Service database between 2002 and 2015.
After propensity score matching at a 1:5 ratio, the final analysis included 41,148 individuals aged 18 years or older who were diagnosed with migraine between 2003 and 2008, and 205,741 individuals without migraine.
Multivariate Cox hazards regression analysis showed that patients with migraine had a higher risk for open-angle glaucoma onset vs. those without migraine (HR = 1.24; P < .001).
The researchers observed that older age, male sex, low-income status, living in a rural area and the presence of hypertension, diabetes or hyperlipidemia were significantly associated with a higher risk for open-angle glaucoma development.
Additionally, they found that, compared with those without migraine, both patients who had migraine with aura (HR = 1.24; P < .001) and without aura (HR = 1.25; P < .001) had a higher risk for open-angle glaucoma onset.
The researchers also noted that patients with migraine aged younger than 40 years vs. 40 years or older had a higher risk for open-angle glaucoma onset (HR = 1.58 vs. 1.17).
“Our study demonstrated that a history of migraine, irrespective of aura status, is associated with an increased risk of open-angle glaucoma onset,” the researchers wrote. “Therefore, ocular examination for open-angle glaucoma may be necessary when migraine patients report symptoms of glaucoma, such as visual field affects.”
Kim and colleagues acknowledged several study limitations, including the limited generalizability of the results to populations outside of South Korea, as well as the fact that it is unknown how many patients with open-angle glaucoma also had normal-tension glaucoma.
Perspective
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Population studies have emphasized the importance of vascular dysregulation in glaucoma, though evidence regarding migraine specifically as a risk factor for open-angle glaucoma is mixed. This study from a nationwide cohort of data from South Korea reported a modest relative risk for development of glaucoma among migraine patients.
To put this into context of other known risk factors for glaucoma, the HR found for migraine in this study was 1.24, which is lower than that of many of the more widely accepted risk factors such as ocular hypertension, family history, thin central corneal thickness and myopia (all of which have accepted HRs of 1.5 or greater).
Thus, the inclusion of a migraine history as a risk factor seems appropriate, but it should not elicit a glaucoma evaluation based on this risk factor alone.
It is apparent that a comprehensive understanding of a patient’s vascular risk factors, including migraine, is warranted. Further research into risk profiles regarding vascular factors in terms of conversion to glaucoma and progression of existing glaucoma may be helpful in this regard.
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