Seminars in Ophthalmology

ISSN: 0882-0538 (Print) 1744-5205 (Online) Journal homepage: http://www.tandfonline.com/loi/isio20

Refractive Errors in Patients with Migraine

Headache

Alime Gunes, Seden Demirci, Levent Tok, Ozlem Tok, Hasan Koyuncuoglu &
Vedat Ali Yurekli

To cite this article: Alime Gunes, Seden Demirci, Levent Tok, Ozlem Tok, Hasan Koyuncuoglu
& Vedat Ali Yurekli (2016) Refractive Errors in Patients with Migraine Headache, Seminars in
Ophthalmology, 31:5, 492-494, DOI: 10.3109/08820538.2014.962177

To link to this article: http://dx.doi.org/10.3109/08820538.2014.962177

Published online: 20 Nov 2014.

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Seminars in Ophthalmology, 2016; 31(5 ): 492 –49 4
© Taylor & Francis
ISSN: 0882-0538 print / 1744-5205 online
DOI: 10.3109/08820538.2014.962177

ORIGINAL ARTICLE

Refractive Errors in Patients with Migraine Headache

Alime Gunes1, Seden Demirci2, Levent Tok 1, Ozlem Tok1,
Hasan Koyuncuoglu 2, and Vedat Ali Yurekli 2

1
Department of Ophthalmology, Faculty of Medicine, Süleyman Demirel University, Isparta, Turkey
and 2Department of Neurology, Faculty of Medicine , Süleyman Demirel University, Isparta, Turkey

University, Isparta, Turkey

ABSTRACT
Purpose: To evaluate refractive errors in patients with migraine headache and to compare with healthy subjects.
Materials and Methods: This prospective case-control study includes patients with migraine and age- and sex-
matched healthy subjects. Clinical and demographic characteristics of the patients were noted. Detailed
ophthalmological examinations were performed containing spherical refractive error, astigmatic refractive
error, spherical equivalent (SE), anisometropia, best-corrected visual acuity, intraocular pressure, slit lamp
biomicroscopy, fundus examination, axial length, anterior chamber depth, and central corneal thickness.
Spectacle use in migraine and control groups was compared. Also, the relationship between refractive
components and migraine headache variables was investigated. Results: Seventy-seven migraine patients with
mean age of 33.27 ± 8.84 years and 71 healthy subjects with mean age of 31.15 ± 10.45 years were enrolled
(p = 0.18). The migraine patients had higher degrees of astigmatic refractive error, SE, and anisometropia when
compared with the control subjects (p = 0.01, p = 0.03, p = 0.02, respectively). Conclusion: Migraine patients may
have higher degrees of astigmatism, SE, and anisometropia. Therefore, they should have ophthalmological
examinations regularly to ensure that their refractive errors are appropriately corrected.
Keywords: Anisometropia, astigmatism, migraine, refractive errors, spherical equivalent

INTRODUCTION not induce any significant headache, substantive

refractive errors may cause headache problems.6
Migraine is one of the most common debilitating Although there have been several studies of
diseases characterized by pulsating headaches con- refractive errors in migraine, the association between
tinued from a few hours to several days, accompanied them is equivocal. Some studies argued that migraine
by nausea, vomiting, sensitivity to light and sound.1 is associated with refractive errors,7–10 but other
Worldwide, 14% of the population have suffered from studies have reported that there is no relationship
migraine at some point.2 Migraine is considered a between them.6,11–13
major cause of disability.2 The cost of a migraine In this study, we aimed to evaluate refractive errors
headache is high in terms of quality of life, absentee- in patients with migraine headaches and to compare
ism from school and work, lost productivity, and them with healthy subjects.
medication expenses.3,4
Currently, migraine headaches can be thought to be
a reaction or biological adaption determined by a MATERIALS AND METHODS
primary disorder of the brain threshold in combin-
ation with a variety of external triggering factors.5 It is The tenets of the Helsinki declaration were followed
also known that visual symptoms are associated with and informed consent was obtained from all partici-
migraine attacks. Although minor refractive errors do pants. The Süleyman Demirel University Department

Received 9 July 2014; accepted 31 August 2014; published online 20 November 2014
Correspondence: Alime Gunes, Assistant Professor. Department of Ophthalmology, Faculty of Medicine, Süleyman Demirel University,
Isparta, Turkey. Tel: +905054828345. E-mail: dralimesefer@hotmail.com

492
 Refractive Errors in Migraine 493

of Medical Sciences ethics committee approved TABLE 1. Comparison of data (Mean ± Standard deviation) in
the study. migraine and control.
Seventy-seven migraine patients and 71 age- and Migraine Control
sex-matched healthy subjects were included in this (n = 154 eyes) (n = 142 eyes) p Value
prospective case-control study. Migraine patients
were aged between 18 years and 50 years with a Age (years) 33.27 ± 8.84 31.15 ± 10.45 0.18
Sphere (D) –0.55 ± 0.51 –0.57 ± 0.49 0.68
frequency of migraine attack of at least one in a Cylinder (D) –0.56 ± 1.52 –0,16 ± 1.16 0.01
month. Migraine diagnosis has been made according SE (D) –0,86 ± 1.62 –0,50 ± 1.22 0.03
to the International Classification of Headache Anisometropia (D) 0.44 ± 0.49 0.29 ± 0.27 0.02
Disorder (ICHD-II).14 Also, migraine variables that BCVA (logMAR) 0.01 ± 0.11 0.00 ± 0.00 0.19
include severity of headache, duration of headache, IOP (mmHg) 15.11 ± 3.00 14.82 ± 3.14 0.42
AL 23.06 ± 1.88 23.26 ± 0.85 0.23
duration of attack, and the number of headaches in ACD 3.38 ± 0.33 3.41 ± 0.36 0.57
the last month were questioned in migraine patients. CCT (mm) 540 ± 34 546 ± 39 0.19
The severity of headache was assessed by Visual
Analogue Scale (VAS) with a score of 0 defining no D: diopter; SE: spherical equivalent; BCVA: best-corrected
visual acuity; logMAR: logarithm of the minimal angle of
pain and 10 defining the worst pain imaginable. resolution; IOP: intraocular pressure; AL: axial length; ACD:
Participants with systemic disease, pregnancy, ocular anterior chamber depth; CCT: central corneal thickness.
trauma, ocular surgery, or ocular disease were
excluded from the study.
All patients were assessed during a headache-free TABLE 2. Correlations between refractive components and
period. Refractive errors were analyzed using an migraine headache variables.
autorefractometer (Tonoref II autorefractor kerat-
ometer, Nidek Co. Ltd.), and spherical refractive Sphere Cylinder SE Anisometropia
(D) (D) (D) (D)
error, astigmatic refractive error, spherical equivalent
(SE), and anisometropia were analyzed separately. Severity of headache r –0.20 0.05 0.02 0.03
Anisometropia was considered to be the interocular (VAS) p 0.01 0.46 0.72 0.79
difference of the SE. Duration of headache r –0.20 0.07 0.04 0.03
Statistical analyses were performed using SPSS (year) p 0.01 0.36 0.54 0.76
software (version 15.0, SPSS, Chicago, IL, USA). Duration of attack r –0.10 0.10 0.18 0.00
Descriptive statistics were performed to report the (hours) p 0.20 0.01 0.02 0.93
age, SE, best-corrected visual acuity (BCVA), intrao- Frequency of attacks r 0.05 –0.14 0.07 0.01
cular pressure (IOP), anterior chamber depth (ACD), (per month) p 0.53 0.07 0.33 0.90
central corneal thickness (CCT), and axial length D: diopter; SE: spherical equivalent; VAS: Visual Analogue
(AL), and descriptive analysis was presented as Scale; r: Pearson Correlation; p: significance.
mean ± standard deviation. Distributions were
tested for normality by Kolmogorov-Smirnov test.
The independent t-test was used to compare the
differences between the groups. Spearman correl- error, SE, and anisometropia (p = 0.01, p = 0.03, p = 0.02,
ations were performed to compare spherical refract- respectively) (Table 1). In the migraine group, 35
ive error, astigmatic refractive error, SE, and patients (45.4%) used spectacles and, in the control
anisometropia with migraine variables of severity group, 30 subjects (42.2%) wore spectacles.
of headache, duration of headache, duration of Twenty-five patients (32.5%) had migraine with
attack, and the number of headaches in the last aura, and 52 (67.5%) migraine without aura. Spherical
month. P values 50.05 were regarded as statistically refractive error, astigmatic refractive error, SE, and
significant. anisometropia were similar in both groups (p = 0.37,
p = 0.60, p = 0.41, p = 0.44, respectively).
The correlations between refractive components
RESULTS and migraine headache variables are shown in
Table 2.
The mean age of the migraine group was 33.27 ± 8.84
years (19–50 years), and 31.15 ± 10.45 years (19–50
years) in the control group (p = 0.18). Sixty-eight DISCUSSION
migraine patients (88.3%) were female and 59 subjects
(83.0%) were female in the control group. The patient Migraine is a common disorder; some of its features
and control groups were similar regarding age, SE, are still not completely understood. Despite intensive
BCVA, IOP, CCT, ACD, and AL (Table 1). research into the pathogenesis and treatment of
Compared with the control group, the migraine migraine, its relationship with refractive error has
group had higher degrees of astigmatic refractive been controversial.6–13
© 2016 Taylor & Francis
494 A. Gunes et al.

Early uncontrolled studies reported that low DECLARATION OF INTEREST

refractive errors, especially astigmatism, are asso-
ciated with migraine.7,8 Turville argued that uncor- The authors report no conflicts of interest. The authors
rected refractive errors were a major cause, or at alone are responsible for the content and writing of
least an important triggering factor, in migraine the paper.
patients.9 Also, he claimed that correction for refract-
ive errors must include both manifest and latent
errors. However, these studies were lacking in terms
of control group and statistical analysis. More REFERENCES
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