Pupil Cycle Time Distinguishes Migraineurs From Subjects Without Headache

Cortez, Melissa; Rae, Natalie; Millsap, Leah; McKean, Nick; Brennan, K. C.

doi:10.3389/fneur.2019.00478

Cited by 8 publications

(8 citation statements)

References 39 publications

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“…Prior studies of pupil response in migraine have obtained varying results. Prior studies have not found migraine group differences in the amplitude of pupil constriction or steady-state pupil size (57)(58)(59)(60), although more subtle changes in pupil dynamics have been reported (58,61,62). Our study differs from many prior reports in that we measured open-loop, consensual pupil responses by combining pharmacologic dilation with an artificial pupil, thus controlling retinal irradiance across the studied groups.…”

Section: Discussionmentioning

confidence: 80%

Selective amplification of ipRGC signals accounts for interictal photophobia in migraine

McAdams

Kaiser

Igdalova

et al. 2020

Proc. Natl. Acad. Sci. U.S.A.

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Second only to headache, photophobia is the most debilitating symptom reported by people with migraine. While the melanopsin-containing intrinsically photosensitive retinal ganglion cells (ipRGCs) are thought to play a role, how cone and melanopsin signals are integrated in this pathway to produce visual discomfort is poorly understood. We studied 60 people: 20 without headache and 20 each with interictal photophobia from migraine with or without visual aura. Participants viewed pulses of spectral change that selectively targeted melanopsin, the cones, or both and rated the degree of visual discomfort produced by these stimuli while we recorded pupil responses. We examined the data within a model that describes how cone and melanopsin signals are weighted and combined at the level of the retina and how this combined signal is transformed into a rating of discomfort or pupil response. Our results indicate that people with migraine do not differ from headache-free controls in the manner in which melanopsin and cone signals are combined. Instead, people with migraine demonstrate an enhanced response to integrated ipRGC signals for discomfort. This effect of migraine is selective for ratings of visual discomfort, in that an enhancement of pupil responses was not seen in the migraine group, nor were group differences found in surveys of other behaviors putatively linked to ipRGC function (chronotype, seasonal sensitivity, presence of a photic sneeze reflex). By revealing a dissociation in the amplification of discomfort vs. pupil response, our findings suggest a postretinal alteration in processing of ipRGC signals for photophobia in migraine.

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Section: Discussionmentioning

confidence: 80%

Selective amplification of ipRGC signals accounts for interictal photophobia in migraine

McAdams

Kaiser

Igdalova

et al. 2020

Proc. Natl. Acad. Sci. U.S.A.

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“…In another report, increased pupil cycle time in probable, episodic, and chronic migraine was associated with mixed hypofunction of both sympathetic and parasympathetic innervation. 11 On the other hand, in the study of Koban et al there was no difference in pupil size measured during the ictal and interictal period in migraine patients. They also found no difference between migraine patients and controls.…”

Section: Discussionmentioning

confidence: 85%

“…[6][7][8] Although previous studies reported sympathetically Effect of migraine attack on pupil size, accommodation and ocular aberrations mediated pupillary dysfunction in patients with migraine, some studies suggested mixed parasympathetic and sympathetic dysfunction. [9][10][11] The autonomic nervous system regulates many ocular functions, such as pupil reflexes, accommodation, ocular blood flow, and intraocular pressure. Accommodation is a natural adaptive optical mechanism for improving the retinal image of a nearby object.…”

Section: Introductionmentioning

confidence: 99%

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Effect of migraine attack on pupil size, accommodation and ocular aberrations

Yıldız

Balcı

et al. 2020

European Journal of Ophthalmology

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Purpose: To evaluate the pupil size, accommodation, and ocular higher-order aberrations (HOAs) in patients with migraine during migraine attacks and compare them with interictal period and healthy controls. Methods: This prospective, case–control study included 48 eyes of 24 patients with migraine and 48 eyes of 24 age and sex-matched healthy controls. Measurements were performed using a Hartmann Shack aberrometer. Accommodative responses to accommodative stimulus ranging from 0 to 5 diopters (D) in increments of 0.5 D were recorded. Spherical, coma, trefoil aberration, and root mean square (RMS) of total HOAs were assessed. Patients with migraine were measured twice during the interictal phase and during migraine attack. Results: The mean pupil size significantly decreased during migraine attack (5.85 ± 0.19 mm) compared with the interictal phase (6.05 ± 0.19 mm) in the patients with migraine ( p = 0.012). There was a significant increase in the accommodative response to accommodative stimulus of 1.5 to 5 D during migraine attack. No significant change was observed in HOAs during migraine attack. In addition, no ictal or interictal period measurements were statistically significantly different from the controls. Comparing symptomatic and non-symptomatic sides in 17 migraine patients with unilateral headache, no significant difference was found in any of the measurements in both ictal and interictal periods. Conclusion: Our results suggest the presence of a subtle oculosympathetic hypofunction in patients with migraine during the ictal period compared to the interictal period. The accommodation status of the eye seems to be affected by this autonomic dysfunction.

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“…Furthermore, cardiac vagal responses via baroreceptors are reduced in migraine patients, but sympathetic system-related responses are not. As a consequence, it appears that the autonomic nervous system may play a role in the pathophysiology of migraine [21]. The pupillary hippus phenomenon can be extinguished with antagonists of the parasympathetic nervous system, whereas antagonists of the sympathetic system dilate the pupils without blocking the hippus: this suggests that the phenomenon originates in the centrally localized parasympathetic system and not in the sympathetic system [10].…”

Section: Discussionmentioning

confidence: 99%

“The Pupillary (Hippus) Nystagmus”: A Possible Clinical Hallmark to Support the Diagnosis of Vestibular Migraine

Gufoni¹,

Casani²

2023

JCM

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(1) Background: Hippus (which in this paper will be called “Pupillary nystagmus”) is a well-known phenomenon which has never been related to any specific pathology, so much so that it can be considered physiological even in the normal subject, and is characterized by cycles of dilation and narrowing of the pupil under constant lighting conditions. The aim of this study is to verify the presence of pupillary nystagmus in a series of patients suffering from vestibular migraine. (2) Methods: 30 patients with dizziness suffering from vestibular migraine (VM), diagnosed according to the international criteria, were evaluated for the presence of pupillary nystagmus and compared with the results obtained in a group of 50 patients complaining of dizziness that was not migraine-related. (3) Results: Among the 30 VM patients, only two cases were found to be negative for pupillary nystagmus. Among the 50 non-migraineurs dizzy patients, three had pupillary nystagmus, while the remaining 47 did not. This resulted in a test sensitivity of 0.93% and a specificity of 0.94%. (4) Conclusion: we propose the consideration of the presence of pupillary nystagmus as an objective sign (present in the inter-critical phase) to be associated with the international diagnostic criteria for the diagnosis of vestibular migraine.

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Pupil Cycle Time Distinguishes Migraineurs From Subjects Without Headache

Cited by 8 publications

References 39 publications

Selective amplification of ipRGC signals accounts for interictal photophobia in migraine

Selective amplification of ipRGC signals accounts for interictal photophobia in migraine

Effect of migraine attack on pupil size, accommodation and ocular aberrations

“The Pupillary (Hippus) Nystagmus”: A Possible Clinical Hallmark to Support the Diagnosis of Vestibular Migraine

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