Microvascular involvement in migraine: an optical coherence tomography angiography study

Romozzi, Marina; Cuffaro, Giovanni; Rollo, Eleonora; Mattei, Roberta; Marcelli, Sofia; Rizzo, Stanislao; Calabresi, Paolo; Servidei, Serenella; Savino, Gustavo; Vollono, Catello

doi:10.1007/s00415-023-11697-z

Cited by 7 publications

(4 citation statements)

References 25 publications

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“…However, the differences were not statistically significant, which is somewhat different from the previous meta-analysis results ( 44 ). The posterior regions of the cerebral hemispheres were usually more significantly malperfused during migraine attacks in patients with MA compared to patients with MO ( 45 ). The lack of statistical difference between the two in the current meta-analysis could be owing to various factors such as the sample size of the included studies, migraine variables, and ethnic differences.…”

Section: Discussionmentioning

confidence: 93%

Retina and microvascular alterations in migraine: a systemic review and meta-analysis

Liu,

Jie,

Wang

et al. 2023

Front. Neurol.

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ObjectiveThis study aimed to evaluate the retina and microvascular alterations with optical coherence tomography (OCT) or optical coherence tomography angiography (OCTA) in patients with migraine with aura (MA) and migraine without aura (MO).MethodsPubMed, Embase, and Cochrane Library databases were searched to find relevant literature on patients with MA or MO using OCT/OCTA devices. The eligible data were analyzed by Stata Software (version 15.0).ResultsThere were 16 studies identified, involving 379 eyes with MA, 583 eyes with MO, and 658 eyes of healthy controls. The thickness of the peripapillary retinal nerve fiber layer (pRNFL) of patients with MA decreased significantly in most regions. The foveal avascular zone (FAZ) area and perimeter in MA patients significantly enlarged, while the perfusion density (PD) in the macular deep capillary plexus (mDCP) significantly decreased in the whole image and its subregions except for the fovea, with the PD in radial peripapillary capillary (RPC) decreasing inside the disk. Patients with MO demonstrated a significantly decreased thickness of pRNFL in most regions, and the FAZ parameters were significantly enlarged. No statistical significance was observed in the retina and microvascular features of patients with MA and MO.ConclusionThe eyes affected by MA and MO demonstrated significantly reduced thickness of pRNFL and enlarged FAZ. Patients with MA showed retinal microvascular impairments, including a decreased PD in mDCP. The OCT and OCTA could detect membrane morphology and circulation status in migraine and might provide the basis for the diagnosis and follow-up of patients with migraine.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/, CRD42023397653.

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Section: Discussionmentioning

confidence: 93%

Retina and microvascular alterations in migraine: a systemic review and meta-analysis

Liu,

Jie,

Wang

et al. 2023

Front. Neurol.

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“…Migraineurs with aura could have a higher cerebrovascular risk ( Sacco et al, 2012 ), corresponding to a higher ischemic risk in the retina and choroid than controls and those without aura ( Kanar et al, 2021 ), perhaps due to endothelial/smooth-muscle dysfunction and hypercoagulability ( Larrosa-Campo et al, 2012 ). The posterior cerebral hemispheres are similarly less perfused ictally in aura migraineurs than non-aura migraineurs ( Romozzi et al, 2023 ). Repetitive migraine attacks involving transient vasoconstrictions could ultimately result in permanent retinal and general cerebral damage ( Feng et al, 2016 ), especially through hypoperfusion of the optic nerve, retina, and choroid through cerebral and retrobulbar vessels and retinal and ciliary arteries repetitively constricting over time in chronic migraineurs ( Ascaso et al, 2017 ).…”

Section: Discussionmentioning

confidence: 99%

Using optical coherence tomography and optical coherence tomography angiography to delineate neurovascular homeostasis in migraine: a review

Chaliha,

Vaccarezza,

Charng

et al. 2024

Front. Neurosci.

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Migraine is one of the world’s most debilitating disorders, and it has recently been shown that changes in the retina can be a potential biomarker for the disease. These changes can be detected by optical coherence tomography (OCT), which measures retinal thickness, and optical coherence tomography angiography (OCTA), which measures vessel density. We searched the databases Google Scholar, ProQuest, Scopus, and Web of Science for studies in English using OCT and OCTA in migraineurs, using the search terms “optical coherence tomography,” “OCT,” “optical coherence tomography angiography,” “OCTA” and “migraine.” We found 73 primary studies, 11 reviews, and 8 meta-analyses pertaining to OCT and OCTA findings in migraineurs. They showed that migraineurs had reduced retinal thickness (via OCT), retinal vessel density, and greater foveal avascular zone area (via OCTA) than controls. OCTA changes reflect a perfusion compromise occurring in migraineurs as opposed to in healthy controls. OCT and OCTA deficits were worse in migraine-with-aura and chronic migraine than in migraine-without-aura and episodic migraine. Certain areas of the eye, such as the fovea, may be more vulnerable to these perfusion changes than other parts. Direct comparison between study findings is difficult because of the heterogeneity between the studies in terms of both methodology and analysis. Moreover, as almost all case–control studies were cross-sectional, more longitudinal cohort studies are needed to determine cause and effect between migraine pathophysiology and OCT/OCTA findings. Current evidence suggests both OCT and OCTA may serve as retinal markers for migraineurs, and further research in this field will hopefully enable us to better understand the vascular changes associated with migraine, perhaps also providing a new diagnostic and therapeutic biomarker.

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“…Migraine with aura (MA) has been reported to be associated with a thinning of various retinal layers including the retinal nerve fiber layer, [25][26][27][28][29][30][31][32][33][34] ganglion cell layer, 30,35 choroid layer, 29,36 and increased size of the foveal avascular zone (FAZ). 37,38 Several studies have also investigated the retinal vasculature in the migraine population in the interictal state [38][39][40][41] using skeletonized or binarized OCTA derived measures (such as vessel area density [VAD] and vessel skeleton density [VSD]) and have shown a decrease in vascular density in various areas including foveal and parafoveal regions. These vascular density measures are thought to approximate blood flow, but due to their binary nature (presence or absence of vessel) do not consider the intensity of the OCTA signal.…”

Section: Backg Rou N Dmentioning

confidence: 99%

“…Variable results have been reported, possibly due to variability related to study design, populations studied, and differences in technical aspects of the studies owing to various OCT/OCTA machines used. Migraine with aura (MA) has been reported to be associated with a thinning of various retinal layers including the retinal nerve fiber layer, 25–34 ganglion cell layer, 30,35 choroid layer, 29,36 and increased size of the foveal avascular zone (FAZ) 37,38 . Several studies have also investigated the retinal vasculature in the migraine population in the interictal state 38–41 using skeletonized or binarized OCTA derived measures (such as vessel area density [VAD] and vessel skeleton density [VSD]) and have shown a decrease in vascular density in various areas including foveal and parafoveal regions.…”

Section: Introductionmentioning

confidence: 99%

Reduction in retinal microvascular perfusion during migraine attacks

Podraza,

Bangera,

Feliz

et al. 2023

Headache

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ObjectiveTo determine if there are changes in structure and function of the retinal vasculature during and between migraine attacks using optical coherence tomography angiography (OCTA).BackgroundMigraine attacks commonly include visual symptoms, but the potential role of the retina in these symptoms is not well understood. OCTA is a rapid, non‐invasive imaging technique that is used to visualize the retinal microvasculature with high spatial resolution in a clinical setting. In this study we used OCTA to quantify different features of the retinal vasculature in patients with migraine during and between attacks, as well as in healthy controls (HCs).MethodsWe performed a prospective cohort study of 37 patients with migraine with aura (MA) (median [interquartile range, IQR] age of 37 [14] years, 86% female) and 30 with migraine without aura (MO) (median [IQR] age of 37 [17] years, 77% female) and 20 HCs (median [IQR] age of 35 [7] years, 50% female). Macular OCTA scans were obtained for all participants for the interictal analysis. In 12 MA and eight MO, scans were captured both during and outside of migraine attacks and five HCs had initial and repeat scans. In addition to analyzing the morphology of the foveal avascular zone, we calculated the vessel flux index (VFI), which is an indicator of retinal perfusion and conventional metrics (such as vessel area density) in the foveal and parafoveal regions.ResultsThere was a significant difference in the parafoveal VFI in the ictal state between the groups (p = 0.009). During migraine attacks there was a significant reduction in the parafoveal region VFI in MA (−7%, 95% confidence interval [CI] −10% to −4%; p = 0.006) and MO (−7%, 95% CI −10% to −3%; p = 0.016) from their interictal baseline as compared to the change between repeat scans in HCs (2%, 95% CI −3% to 7%). Interictally, there was a mean (standard deviation [SD]) 13% (10%) (p = 0.003) lower blood perfusion in the MA group as compared to the MO group in the foveal region (mean [SD] 0.093 [0.023] vs. 0.107 [0.021], p = 0.003). Interictal analysis also revealed higher circularity in the superficial foveal avascular zone in the MA group compared with the MO group (mean [SD] 0.686 [0.088] vs. 0.629 [0.120], p = 0.004). In addition, interictal analysis of the patients with MA or MO and unilateral headache showed increased retinal vascular parameters consistent with greater perfusion in the eye ipsilateral to the side of the pain as compared with the contralateral eye.ConclusionsThese results indicate that perfusion is reduced in MA and MO in the parafoveal retina during the ictal period. Interictally, the foveal retina in MA has reduced perfusion when compared to the foveal retina in MO. Patients with unilateral headache showed interictal asymmetry of retinal perfusion between eyes. These results indicate that changes in retinal perfusion could be a part of migraine pathophysiology, and that distinct retinal vascular signatures identified with OCTA could represent biomarkers for migraine.

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Microvascular involvement in migraine: an optical coherence tomography angiography study

Cited by 7 publications

References 25 publications

Retina and microvascular alterations in migraine: a systemic review and meta-analysis

Retina and microvascular alterations in migraine: a systemic review and meta-analysis

Using optical coherence tomography and optical coherence tomography angiography to delineate neurovascular homeostasis in migraine: a review

Reduction in retinal microvascular perfusion during migraine attacks

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