Optical Coherence Tomography in Patients with Chronic Migraine: Literature Review and Update

Abstract

Migraine is a chronic disease characterized by unilateral, pulsating, and often moderate-to-severe recurrent episodes of headache with nausea and vomiting. It affects approximately 15% of the general population, yet the underlying pathophysiological mechanisms are not fully understood. Optical coherence tomography (OCT) is a safe and reproducible diagnostic technique that utilizes infrared wavelengths and has a sensitivity of 8–10 μm. It can be used to measure thinning of the retinal nerve fiber layer (RNFL) in some neurological disorders. Although ophthalmologists are often the first specialists to examine patients with migraine, few studies have addressed the involvement of the optic nerve and retino-choroidal structures in this group. We reviewed the literature on the etiological and pathological mechanisms of migraine and the relationship between recurrent constriction of cerebral and retrobulbar vessels and ischemic damage to the optic nerve, retina, and choroid. We also assessed the role of OCT for measuring peripapillary RNFL thickness and macular and choroidal changes in migraine patients. There is considerable evidence of cerebral and retrobulbar vascular involvement in the etiology of migraine. Transitory and recurrent constriction of the retinal and ciliary arteries may cause ischemic damage to the optic nerve, retina, and choroid in patients with migraine. OCT to assess the thickness of the peripapillary RNFL, macula, and choroid might increase our understanding of the pathophysiology of migraine and facilitate diagnosis of retino-choroidal compromise and follow-up of therapy in migraine patients. Future studies should determine the usefulness of OCT findings as a biomarker of migraine.

Retinal Nerve Fiber Layer Thickness and Oxidative Stress Parameters in Migraine Patients without Aura: A Pilot Study

“…The retinal nerve fiber layer (RNFL) contains the axons of the retinal ganglion cells. Therefore, measurement of the RNFL thickness by OCT is expected to provide information for monitoring the progressive loss of ganglion cells and axons in migraine patients [ 23 ].…”

“…Since its introduction in the clinical practice, optical coherence tomography (OCT) represents one of the most reliable methods for the evaluation of morphological changes in retinal and optic nerve structure [ 22 ]. OCT changes can indicate the retrograde trans-synaptic neuronal degeneration (RTSD) of the retinal ganglion cells (RGCs) [ 23 ], being useful for the evaluation of the neurodegenerative process associated with various neurological diseases, such as multiple sclerosis [ 24 ], Alzheimer’s disease [ 25 ], Parkinson’s disease [ 26 ], and various type of headache, including migraine [ 23 ]. OCT provides information about the axonal and neuronal loss in the retina, and consequently, offers information in the visual afferent pathways and central nervous system, facilitating the diagnosis and the management of neuro-ophthalmological diseases [ 27 ].…”

Comparison of retinal nerve fiber layer thickness between normal population and patients with diabetes mellitus using optical coherence tomography

“…Assessment of Retinal Nerve Fiber Layer (RNFL) thickness has been in clinical practice for early detection of glaucoma 3. Since glaucoma is a form of optic neuropathy, researchers have found variation in RNFL thickness in patients suffering from various neuropathies like migraine, Alzheimer’s disease, multiple sclerosis, obstructive sleep apnea and neurofibromatosis 4-8…”

Retinal correlates of neurological disorders

“…Retinal correlates have been observed in a range of some of the most common neurological disorders, some of which are not commonly associated with visual symptoms. Further to those conditions discussed, retinal correlates have been found in other neurological diseases such as idiopathic intracranial hypertension (IIH), 348 chronic migraines, 349–351 and a range of psychiatric conditions. 352,353 The majority of evidence exists in the form of cross-sectional studies comparing disease groups and healthy controls; however, further work must be done to take advantage of the unique opportunity the eye provides to serially image subjects through time.…”