Retinal Neurovascular Structural Changes in Optical Coherence Tomography and the Relationship between These Changes and White Matter Hyperintensities in Patients with Migraine

Abstract

<b><i>Introduction:</i></b> This study aimed to reveal whether retinal nerve fiber layer (RNFL), ganglion cell layer (GCL) inner plexiform layer, and choroidal layer (CL) thicknesses differed in patients with migraine. Optical coherence tomography (OCT) was used to measure these neurovascular structural changes and determine the relationship between these structures and cranial white matter hyperintensities (WMHs). <b><i>Methods:</i></b> This retrospective comparative registry study included a total of 155 individuals aged 18–55 (mean, 33.50 ± 8.34), consisting of 110 migraine patients and 45 healthy controls. <b><i>Results:</i></b> RNFLs were thinner in the migraine group than the control group but not to a statistically significant degree. However, in both eyes, peripapillary RNLF thickness in some specific quadrants was found to be significantly thinner in the patient group than the control group. GCLs were significantly thinner in the migraine group than the control group. CLs were significantly thicker in the migraine group than in the control group. There was no significant difference between the OCT parameters of patients with and without WMH. An inverse correlation was found between disease duration and CL thickness. CLs were significantly thicker in patients in attack periods than those in attack-free periods. There was no significant difference between the OCT parameters of the migraine with aura and migraine without aura subgroups. <b><i>Discussion/Conclusions:</i></b> Retinal neural and vascular structures might be affected in migraine sufferers, including those in subgroups. Rebound vasodilation may cause alterations in CL thickness during a migraine attack. Factors other than hypoperfusion may contribute to the pathophysiology responsible for the formation of WMH.

Abnormalities of retinal structure and microvasculature are associated with cerebral white matter hyperintensities

“…OCT has been used to research neuroinflammatory and neurodegenerative diseases, such as multiple sclerosis, neuromyelitis optica spectrum disorder, Alzheimer's disease and Parkinson's disease [11,[13][14][15], and may aid our understanding of the pathogenesis and pathophysiology of CSVD. Indeed, the PRNFL thickness was significantly reduced in CADASIL patients and CSVD patients with severe WMHs [16], although undetermined correlations have also been reported [17] and additional research is needed.…”

Using optical coherence tomography and optical coherence tomography angiography to delineate neurovascular homeostasis in migraine: a review

“…We found 35 studies examining specifically the RNFL in migraineurs and found that studies have inconsistently shown that migraineurs have thinner RNFL than controls ( Cunha et al, 2008 ; Costello, 2009 ; Gipponi et al, 2013 ; Sorkhabi et al, 2013 ; Ekinci et al, 2014 ; Demircan et al, 2015 ; Yülek et al, 2015 ; Acer et al, 2016 ; Demirci et al, 2016 ; Feng et al, 2016 ; Verroiopoulos et al, 2016 ; Ergiyit, 2017 ; Reggio et al, 2017 ; Tunç et al, 2017 ; Abdellatif and Fouad, 2018 ; Tak et al, 2018 ; Bing et al, 2019 ; Ulusoy et al, 2019 ; You et al, 2019 ; Sirakaya et al, 2020 ; Yener and Yılmaz, 2020 ; Altunisik and Oren, 2021 ; Kanar et al, 2021 ; Panicker et al, 2021 ; Temel et al, 2021 ; Yurtoğulları et al, 2021 ), generally ipsilateral to the usual side of headache ( Martinez et al, 2008 ; Gunes et al, 2016 ; Khosravi et al, 2018 ). Lin et al examined 26 studies and also found thinner mean RNFL in migraineurs than in controls, especially in the superior and inferior eye quadrants ( Lin et al, 2021 ).…”

“…Nineteen studies showed ganglion cell complex thinning in migraineurs (Güler et al, 2020). Compared to controls, both aura and non-aura migraineurs had thinner GCL (Ekinci et al, 2014;Reggio et al, 2017;Abdellatif and Fouad, 2018;Altunisik and Oren, 2021;Yurtoğulları et al, 2021), where chronicity and severity yielded greater GCL reduction (Abdellatif and Fouad, 2018). The presence of WMH did not influence this effect (Altunisik and Oren, 2021).…”

“…In migraineurs without aura, those with WMH had thinner RNF, a superior hemisphere, and superior layers than those without ( Ulusoy et al, 2019 ). Additional non-perfusion-related factors may also contribute to WMH formation ( Altunisik and Oren, 2021 ).…”

“…Both aura (more so those with WMH than those without) and non-aura migraineurs had reduced whole optic disc VD compared to controls ( Ulusoy et al, 2019 ). Different peripapillary areas of the left and right eyes may have RNFL thinning in migraineurs compared to controls ( Altunisik and Oren, 2021 ). In some studies, investigators found no differences between aura and non-aura migraineurs ( Altunisik and Oren, 2021 ; Kanar et al, 2021 ; Yurtoğulları et al, 2021 ).…”