Migrainous infarction of the eye: Two cases of monocular ischemic complications associated with retinal migraine

Chhabra, Nikita; Chiang, Chia‐Chun; Nome, Marie A. Di; Houghton, Odette M.; Carlin, Rachel E; O’Carroll, Cumara B; Dodick, David W.; Dumitrascu, Oana M.

doi:10.1177/03331024211056286

Cited by 5 publications

(4 citation statements)

References 12 publications

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“…The headache is preceded by aura symptoms, usually visual disturbances, in a third of migraine sufferers (4). For many years, migraine has been thought to be associated with a variety of ophthalmic diseases, such as central retinal artery and vein occlusions, anterior and posterior ischemic optic neuropathy, and normal-tension glaucoma (5)(6)(7)(8). One study showed that 24% of patients with retinal arterial occlusions had a history of migraine (9).…”

Section: Introductionmentioning

confidence: 99%

Analysis of macular microvasculature with optical coherence tomography angiography for migraine: A systematic review and meta-analysis

Yu²,

Liu³

et al. 2022

Front. Neurol.

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ObjectiveThis study aimed to evaluate the features of macular microvasculature with optical coherence tomography angiography (OCTA) among migraine patients.MethodsWe systematically searched PubMed, Web of Science, Embase, and Cochrane Library for studies that evaluated the macular microvasculature of migraine patients. The weighted mean differences (WMDs) of the foveal avascular zone (FAZ), foveal superficial capillary plexus (SCP) vessel density (VD), parafoveal SCP VD, foveal deep capillary plexus (DCP) VD, and parafoveal DCP VD with 95% confidence intervals (CIs) among migraine with aura (MA) group, migraine without aura (MO) group, and healthy controls (HC) group were analyzed using a random-effect model. P < 0.05 was considered significant in statistical analyses. Publication bias was assessed using funnel plots and statistical tests (Egger's test and Begg's test).ResultsNine studies covering 675 individuals were enrolled in this meta-analysis ultimately. The FAZ of MA patients was not significantly different from HC (WMD = 0.04, 95% CI −0.00 to 0.09). However, the FAZ of MA was significantly larger than that of HC after correction of publication bias by trim and fill method (WMD = 1.03, 95% CI 0.99 to 1.08). The FAZ of MO patients was similar to that of HC (WMD = 0.03, 95% CI −0.00 to 0.07), while smaller than that of MA patients (WMD = 0.05, 95% CI 0.01 to 0.09). VD of the SCP, either in the foveal or parafoveal area, was not significantly different among the three groups. As for DCP, VD in MA patients was lower when compared with HC in the parafovea (WMD = −1.20, 95% CI −1.88 to −0.51).ConclusionsWe found that there was a larger FAZ in MA compared with HC after adjusting for publication bias. The FAZ in MO was not significantly different from that in HC, but significantly lower than that in MA. There was no significant difference in either foveal or parafoveal VD of SCP among MA, MO, and HC participants, while the parafoveal VD of the DCP in MA was lower than that of the HC.

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Section: Introductionmentioning

confidence: 99%

Analysis of macular microvasculature with optical coherence tomography angiography for migraine: A systematic review and meta-analysis

Yu²,

Liu³

et al. 2022

Front. Neurol.

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“…Reduced perfusion in the retina during migraine attacks could play a role in pathological processes in the eye. It has been reported that migraine is associated with an increased risk of retinal artery occlusion, 84 and there have been a few case reports of retinal infarction associated with retinal migraine attacks 85,86 . However, in both clinical practice and in the literature, these are rare reports and there is no overwhelming evidence that migrainous infarction occurs commonly whether in the brain 87 or retina.…”

Section: Discussionmentioning

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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“…Migraineurs may have acute and chronic changes in ocular perfusion, and recurrent migraines can also cause permanent damage to the brain and retina [251,252]. It has been reported that migraine is closely associated with various neurovascular eye diseases such as retinal artery occlusion, ischemic optic neuropathy, and glaucoma [253][254][255].…”

Section: Migrainementioning

confidence: 99%

Optical Coherence Tomography Angiography: Revolutionizing Clinical Diagnostics and Treatment in Central Nervous System Disease

Shen,

Zhang,

et al. 2024

Aging and disease

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Optical coherence tomography angiography (OCTA), as a new generation of non-invasive and efficient fundus imaging technology, can provide non-invasive assessment of vascular lesions in the retina and choroid. In terms of anatomy and development, the retina is referred to as an extension of the central nervous system (CNS). CNS diseases are closely related to changes in fundus structure and blood vessels, and direct visualization of fundus structure and blood vessels provides an effective "window" for CNS research. This has important practical significance for identifying the characteristic changes of various CNS diseases on OCTA in the future, and plays a key role in promoting early screening, diagnosis, and monitoring of disease progression in CNS diseases. This article reviews relevant fundus studies by comparing and summarizing the unique advantages and existing limitations of OCTA in various CNS disease patients, in order to demonstrate the clinical significance of OCTA in the diagnosis and treatment of CNS diseases.

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Migrainous infarction of the eye: Two cases of monocular ischemic complications associated with retinal migraine

Cited by 5 publications

References 12 publications

Analysis of macular microvasculature with optical coherence tomography angiography for migraine: A systematic review and meta-analysis

Analysis of macular microvasculature with optical coherence tomography angiography for migraine: A systematic review and meta-analysis

Reduction in retinal microvascular perfusion during migraine attacks

Optical Coherence Tomography Angiography: Revolutionizing Clinical Diagnostics and Treatment in Central Nervous System Disease

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