Dry eye disease is more prevalent in migraine

A case-control study from India demonstrated that (severe) dry eye disease is more prevalent in patients with migraine compared with people without migraine [1]. Headache severity was significantly associated with dry eye disease (DED). Also, severe dry eye disease was significantly associated with increased frequency and severity of headache in patients with migraine.

Migraine headaches and dry eye disease are important health concerns, both being highly prevalent, debilitating, and known to decrease quality of life [2]. Hence, their association warrants further exploration.

The relation between migraine and dry eye disease is bidirectional and has been tested both ways, Dr Bithi Chowdhury (Hindu Rao Hospital and MDMC Medical College, India) mentioned. A previous Korean population-based study found dry eye disease to be significantly more prevalent in patients with migraine compared with controls (14.4% vs 8.2%; P=0.0001). Moreover, the presence of migraine was found to increase the odds of a dry eye diagnosis 1.6-fold and the odds of dry eye symptoms 1.3-fold [3]. Similarly, more patients with migraine tend to have a dry eye diagnosis than without migraine [4], in patients with migraine visual function and overall quality of life is correlated with dry eye symptoms [5], and the presence of a dry eye diagnosis increases the odds of a migraine diagnosis [6].

The current cross-sectional, observational, hospital-based study from India included 60 consecutive preventive-drug-naïve patients with migraine and 60 controls (i.e., patients presenting with refractive error without any migraine), aged 18–65 years [1]. Patients with comorbidities that can cause dry eye disease were excluded. Severe dry eye disease was diagnosed using the ODISSEY algorithm. Only the severely affected eye was used for comparison.

The mean tear break-up time (11.65 vs 14.30 seconds) and fluorescein scores (1.125 vs 0.692) were significantly worse in patients with migraine compared with controls (P=0.010). The prevalence of dry eye disease was found to be significantly higher in patients with migraine compared with controls (46.7% vs 18.3%; P<0.001). Moreover, severe dry eye disease was found to be significantly more prevalent in patients with migraine versus controls (16.7% vs 1.6%, P<0.001; see Figure).

Figure: Prevalence of (severe) dry eye disease [1]



Among patients with migraine, only mean pain severity was significantly associated with the presence of dry eye disease. Patients with migraine with severe dry eye disease had a higher frequency and severity of headache attacks. Together, these results suggest an association between dry eye and migraine.

1. Chowdhury B, et al. Dry eye disease in migraine: A case control study. AL05, IHC 2021, 8–12 September.
2. McDonald M, et al. Ocul Surf. 2016;14(2):144–67.
3. Ozudogru S, et al. Headache. 2019;59(10):1714–21.
4. Yang S, et al. Curr Eye Res. 2017;42(6):837–41.
5. Ismail OM, et al. JAMA Ophthalmol. 2019;137(5):532–6.
6. Wang TJ, et al. Acta Ophthalmol. 2012;90(7):663–8.

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Posted on 8 November 2021