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Editors Selection IGR 17-3

Glaucoma and Systemic Diseases: Migraine and Vasospasm

Comment by Ki Ho Park on:

65798 Migraine and Vasospasm in Glaucoma: Age-Related Evaluation of 2027 Patients With Glaucoma or Ocular Hypertension, Gramer G; Weber BH; Gramer E, Investigative Ophthalmology and Visual Science, 2015; 56: 7999-8007

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Gramer et al. evaluated the frequency of migraine, vasospasm, family history of migraine, and family history of glaucoma in a group of patients with primary open-angle glaucoma (POAG), normal-tension glaucoma (NTG), pigmentary glaucoma, pseudoexfoliation glaucoma (PEX), ocular hypertension (OH), and primary angle-closure glaucoma (PACG). This is the first study to evaluate family history of migraine in glaucoma patients and the association of family history of glaucoma with frequency of migraine.

According to the authors' findings, migraine was significantly more frequent in NTG (21.4%) than in POAG (13.1%; P = 0.01), PEX (7.8%; P = 0.02), and PACG (10.1%; P = 0.004). Additionally, they reported that patients with a family history of glaucoma had a significantly higher frequency of migraine than did patients without any such history.

This study supports the idea that ischemia due to vasoconstriction can cause glaucomatous optic nerve damage and that risk factors other than IOP play a relatively larger role in NTG than in POAG

The strength of the paper is that the assessment of family history of glaucoma and other risk factors was performed in different glaucomas in a uniform way, i.e., by one glaucoma specialist using a standardized questionnaire.

The limitation of the study is that the presence or absence of migraine or vasospasm was determined in most cases by patients' questionnaire answer, while only some more recent cases had been diagnosed by neurologists. Even so, this inaugural report on the association of migraine frequency and glaucoma, based on the uniform examination by one glaucomatologist of a large number of subjects, is important and deserves its place in the literature.

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