Migraines Linked to Increased Risk of Retinal Artery Occlusion

Patients who experience migraines are at greater risk of developing various types of retinal artery occlusion, according to a recent study published in American Journal of Ophthalmology.

Researchers studied de-identified data from the IBM MarketScan Commercial Claims and Encounters database — one of the largest insurance databases in the United States — and discovered that patients who experience migraines are more likely to suffer from retinal artery occlusion, including central retinal artery occlusion and branch retinal artery occlusion.

People were included in the study if they had been diagnosed with migraines and had been continuously enrolled in the database for at least 2 years. Those who had been enrolled more sporadically (eg, as a result of losing their health insurance or changing insurers) were excluded as they might have received treatment that wasn’t included in the database’s records. Alongside each participant’s history of migraine (or lack thereof), the research team also looked at demographic information and any previous diagnoses of diseases or comorbidities associated with retinal artery occlusion, including cardiac diseases, chronic kidney disease, and vascular risk factors.

Of the 418,965 patients with migraine that met the study’s criteria and were included in the analysis with matched controls, 1060 (0.25%) were eventually diagnosed with retinal artery occlusion, while only 335 (0.08%) of the patients without migraine were diagnosed with the condition. More women were included than men (81.1% compared with 18.9%) and the mean age at diagnosis with migraine was 41.2 years (SD=11.9 years). Overall, the mean age at diagnosis with retinal artery occlusion was 50 years (SD=10.7 years).

Patients with migraine were more likely to have diagnoses and comorbidities known or thought to be associated with retinal artery occlusion, including cardiac diseases, vascular risk factors, hematologic diseases, and chronic kidney disease.

Participants who experienced migraines had a higher risk of developing retinal artery occlusion compared with those without migraine (HR=3.48; 95% CI, 3.07 – 3.94; P <.0001).  And patients who experienced migraines with auras had a higher risk than those who had migraines without auras (HR=1.58; 95% CI, 1.40 – 1.79; P <.001).

Also, patients who were older than 50 years were more likely to have retinal artery occlusion than younger participants.

Researchers found that retinal vasculitis and inflammation were associated with an increased risk of retinal artery occlusion in people with migraines, which emphasized the importance of carefully treating these conditions in patients with migraines.

While scientists have not discovered the exact cause, several hypotheses have been suggested to explain what makes patients with migraines particularly vulnerable to retinal artery occlusion. A possible explanation is that multiple coagulation abnormalities have been detected in patients with migraine. Another is that migraine medications, especially abortive medications for migraine attacks (eg, ergota- mine and triptans), have vasocontrictive properties that might increase the risk of retinal artery occlusion. However, the study did not show a significant link between prescribed triptans and the disease.

Reference

Al-Moujahed A, Tran E, Azad A, et al. Risks of retinal artery occlusion in patients with migraine. Am J Ophthalmol. Published online December 24, 2020. doi:10.1016/j.ajo.2020.11.004