Perimetry and migraine--deficits may not implicate glaucoma.
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Glaucoma, Open-Angle↗
Biomedical subjects
Deacon E Harle
Publications and source records attributed to Deacon E Harle.
The correlation between migraine headache and refractive errors.
PURPOSE: A literature review reveals historical references to an association between migraine headache and refractive errors, but a lack of scientific evidence relating to these claims. METHODS: In a masked case-controlled study, we investigated the four aspects of refractive errors that have been implicated in the literature as correlated with migraine: spherical refractive error, astigmatic refractive error, anisometropia, and uncorrected ametropia. We also compared the calculated scalar value of refractive error, aided and unaided visual acuity, and spectacle use in migraine and control groups. We then investigated the relationship between refractive components and key migraine headache variables. RESULTS: Compared with the control group, the migraine group had higher degrees of astigmatic components of refractive error assessed both objectively (C, p = 0.01; C(0), p = 0.01; C(45), p = 0.05) and subjectively (C, p = 0.03; C(0), p = 0.03; C(45), p = 0.05), uncorrected astigmatic components of refractive error (C(0), p = 0.02; C(45), p = 0.04), and anisometropia (p = 0.06). CONCLUSIONS: Perhaps the historical literature is indeed correct that low degrees of astigmatism and anisometropia are relevant in migraine. Our most significant finding was of higher degrees of astigmatism in the migraine group. This study does indicate that people who experience migraine headaches should attend their optometrist regularly to ensure that their refractive errors are appropriately corrected.
Adult↗
Subtle binocular vision anomalies in migraine.
A literature review reveals old references to an association between migraine headache and binocular vision anomalies, but a lack of scientific evidence evaluating these claims. In a masked case control study, we investigated binocular vision using standard clinical tests in people with migraine and in controls. Some test results suggest that heterophoria and fixation disparity are more common in the migraine group. The migraine group also had slightly reduced stereopsis. We found significant correlations between some migraine variables and some binocular vision variables (e.g., duration of worst headache and impaired stereopsis) but our analyses do not suggest that a causal relationship is likely. In conclusion, people with migraine have on average a slightly higher prevalence of heterophoria and aligning prism, and reduced stereopsis compared with controls. However, the differences are subtle and our data do not support the use of binocular vision interventions prescribed solely on the basis of the presence of migraine.
Adult↗
Visual stimuli are common triggers of migraine and are associated with pattern glare.
OBJECTIVE: To investigate the associations between interictal pattern glare, visual stress, and visual triggers of migraine. BACKGROUND: There has been relatively little research on the visual stimuli that can trigger migraine episodes. This is surprising, since if practitioners can obviate such triggers, then some attacks may be prevented. The existing literature suggests that patients who are prone to visually triggered migraines report more illusions on viewing striped patterns ("pattern glare") and that colored filters may be an effective intervention for these people. METHODS: Headache symptoms and headache triggers were investigated in migraine and control groups in 2 separate experiments. In one experiment, we also determined, for each participant, pattern glare, whether it was reduced by colored filters and, if so, what the optimum color of filter was. Color vision was also assessed with the D15 test. RESULTS: People with migraine saw significantly more illusions on viewing each striped pattern and experienced greater pattern glare. They were also more likely to select a colored filter to aid visual comfort, particularly colors in the blue-to-green sector of the spectrum. Color vision was impaired subtly but significantly in migraine. Principal component analyses grouped common headache triggers into 5 broadly equal components: food, visual triggers, alcohol, stress and tiredness, and the environment. In a second analysis, the overall number of illusions seen in striped patterns was associated with visual triggers while pattern glare, use of colored filters, and interictal light sensitivity together formed a sixth component interpreted as visual stress. CONCLUSIONS: It is suggested that clinicians should ask migraine patients whether visual stimuli trigger their migraine, about interictal visual symptoms, and use the pattern glare test to ensure that those who may benefit from optometric interventions are appropriately managed.
Acute Disease↗
Frequency doubling technology perimetry and standard automated perimetry in migraine.
The literature suggests that visual field defects may be more common in people who experience migraine. The Humphrey frequency doubling (FDT) visual field instrument selectively examines the magnocellular visual pathway, but has not previously been used to investigate visual function in migraine. In a masked controlled study we compared Humphrey FDT and Humphrey Swedish Interactive Threshold Algorithm fields of 25 migraine sufferers with 25 age- and gender-matched controls. Although both mean deviation and pattern standard deviation were a little worse in the migraine group, these differences did not reach statistical significance. There were no inter-eye visual field differences in the migraine group compared with controls. Comparing the mean of all the contrast thresholds in each hemisphere, there were no more inter-hemifield visual field differences in the migraine group compared with controls. There was no significant difference between the migraine and control groups in intra-ocular pressures. The visual field parameters were not correlated with the interval since the last migraine headache, the severity of migraine headache, the duration of migraine headache or the number of migraine headaches per annum. In our data, there was no evidence of visual field deficits, a magnocellular deficit, or indications of glaucomatous pathology.
Adolescent↗
The pupillary light reflex in migraine.
The literature suggests that there may be pupil size and response abnormalities in migraine headache sufferers. We used an infra-red pupillometer to measure dynamic pupil responses to light in 20 migraine sufferers (during non-headache periods) and 16 non-migraine age and gender matched controls. There was a significant increase in the absolute inter-ocular difference of the latency of the pupil light response in the migraine group compared with the controls (0.062 s vs 0.025 s, p = 0.014). There was also a significant correlation between anisocoria and lateralisation of headache such that migraine sufferers with a habitual head pain side have more anisocoria (r = 0.59, p < 0.01), but this was not related to headache laterality. The pupil changes were not correlated with the interval since the last migraine headache, the severity of migraine headache or the number of migraine headaches per annum. We conclude that subtle sympathetic and parasympathetic pupil abnormalities persist in the inter-ictal phase of migraine.
Adult↗
The optometric correlates of migraine.
Migraine is a common, chronic, multi-factorial, neuro-vascular disorder typically characterised by recurrent attacks of unilateral, pulsating headache and autonomic nervous system dysfunction. Migraine may additionally be associated with aura; those focal neurological symptoms that may precede or sometimes accompany the headache. This review describes the optometric aspects of migraine headache. There have been claims of a relationship between migraine headaches and errors of refraction, binocular vision anomalies, pupil anomalies, visual field changes and pattern glare. The quality of the evidence for a relationship between errors of refraction and binocular vision and migraine is poor. The quality of the evidence to suggest a relationship between migraine headache and pupil anomalies, visual field defects and pattern glare is stronger. In particular the link between migraine headache and pattern glare is striking. The therapeutic use of precision-tinted spectacles to reduce pattern glare (visual stress) and to help some migraine sufferers is described.
Asthenopia↗