Retinal Nerve Fibre Layer Thickness of Migraine Patients with or without White Matter Lesions

Abstract

The aim of this study was to determine whether retinal nerve fibre layer (RNFL) thickness is correlated with cerebral white matter lesions (WML) in migraine patients. Forty migraine and 40 healthy subjects were included in this study. The difference in RNFL thickness between the control and a migraine group with WML and a migraine group without WML were investigated using analysis of variance (ANOVA). A Tukey post hoc test was conducted to determine from which group the difference originated. Lower RNFL thicknesses were observed in the migraine patient group where WML was detected using magnetic resonance imaging (MRI), compared with the control group and with the migraine group with no WML. Statistically significant difference was found between the three groups in terms of RNFL thickness. Although there was a statistically significant difference between the control and the migraine group with WML detected with MRI, no statistically significant difference was found in terms of RNFL thickness between the control and the migraine group with no WML related to Tukey post hoc test. Moreover, there was a statistically significant difference between migraine patients with WML and patients without WML in terms of retinal nerve fibre layer thickness. The results indicate that reduction in RNFL detected via optical coherence tomography may be related to cerebral WML in migraine patients. Further studies by neurologists and ophthalmologists are necessary to determine the clinical relevance of the relation between RNFL and cerebral WML. ARTICLE HISTORY

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

“…However, results have not been very consistent. Thus, whereas some authors observed that mean peripapillary RNFL thickness was thinner in migraine patients than in healthy controls, others reported only a thinner RNFL in a specific quadrant ( 16 , 18 , 32 , 56 – 62 ). This selective RNFL involvement might be associated with differences in the vulnerability of retinal axons to ischemia and with focal perimetric changes ( 63 ).…”

“…Several authors have used OCT to study possible changes in macular thickness in patients with migraine. Their results are contradictory because, although most found no change in either foveal or macular parameters in migraine patients ( 18 , 59 , 62 ), some reported that foveal thickness (FT) values ( 19 ) or GCL ( 61 , 64 ) were thinner in MwA than in MwoA. The more diminished blood flow in MwA would explain this finding, given that in MwoA, at least between attacks, pulsatile choroidal blood flow is not compromised.…”

“…This selective RNFL involvement might be associated with differences in the vulnerability of retinal axons to ischemia and with focal perimetric changes ( 63 ). The suspected axonal damage necessitates monitoring of RNFL thickness and visual field testing in migraine patients ( 62 ).…”

“…The possibility of more relevant thinning of RNFL on the headache side could be secondary to lateralized permanent cortical changes, indicating that the hemisphere on the side of pain is more altered. Reduced blood flow has also been demonstrated in the brain on the affected side during attacks ( 62 ). Moreover, Hougaard et al ( 65 ) explored unilateral headaches and investigated the connection between MwA and permanent gray matter anomalies.…”

“…Moreover, Hougaard et al ( 65 ) explored unilateral headaches and investigated the connection between MwA and permanent gray matter anomalies. Using magnetic resonance imaging, Simsek ( 62 ) observed that in migraine patients with white matter lesions (WML), RNFL was thinner than in controls and migraine patients with no WML. Further research should analyze the relationship between brain WML and retinal damage to clarify whether there is a common pathogenic mechanism.…”