Migraine and increased risk of developing open angle glaucoma: a population- based cohort study

DOI: https://doi.org/10.1186/s12886- 019- 1062- 9

Abstract-Summary In the present study, we investigated the risk for open angle glaucoma (OAG) in migraineurs using a 10-year follow-up study that employed a nationwide population- based dataset in Taiwan.

We included 17,283 subjects with migraine in the study cohort and randomly

selected 69,132 subjects from the database for the comparison group.

Multivariate regression analysis was used to assess risk factors for OAG in

migraineurs.

Cox proportional hazards regression was performed to compare the 10-year risk

of OAG between the migraineurs and the comparison cohort.

Migraineurs had more vascular comorbidities than the comparison cohort. The overall incidence of OAG (per 1000 person-years) was 1.29 and 1.02, respectively, for migraineurs and the comparison cohort during the 10-year follow- up period.

Age, hyperlipidemia, and diabetes mellitus were three significant risk factors for

OAG in migraineurs.

After adjusting for patients’ age and vascular comorbidities, migraineurs were found to have a 1.68-fold (95% confidence interval [CI], 1.20–2.36) greater risk of developing OAG than the comparison cohort, in subjects with an ACCI score of 0.

Migraine is associated with a higher risk of OAG for patients with no comorbid-

ity who are aged under 50 years.

Extended: Age, hyperlipidemia, and DM were recognized as significant risk fac-

tors for developing OAG among the migrainous population.

After adjusting for the covariates, the risk of OAG was not significantly higher in

the migraine group (adjusted HR = 1.20, 95% CI =0.99–1.47).

2.3 Comorbidities

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Introduction The association of migraine with open angle glaucoma (OAG) has been reported in two previous population-based studies.

In the Blue Mountains Eye Study, there was no significant association between

typical migraine headache and OAG in all age groups.

In two other studies, patients with low-tension glaucoma had a higher frequency of migraine and headache, based on either neurobehavioral testing or a headache questionnaire [505–507].

Migraine is an intraocular pressure-independent risk factor that is significantly associated with central visual field progression in normal-tension glaucoma patients with autonomic dysfunction [508].

Usui and others reported that the prevalence of migraine in Japanese patients with low-tension glaucoma or primary OAG is not significantly different from that in healthy subjects [509].

The manner by which migraine poses a risk for OAG in patients of different age

groups and comorbidities may differ.

Materials and Methods This study was based on a sub-dataset containing 1 million beneficiaries randomly selected from all insurers, from Taiwan’s National Health Insurance Research Database (NHIRD), an electronic claims database of the Taiwan National Health Insurance (NHI) program, for the period 1996–2010.

Adults aged above 20 years who were diagnosed as having migraine (ICD-9-CM codes 346) between January 1, 2000, and December 31, 2010, and who had no his- tory of glaucoma before enrollment, were included as the case group.

The age- and sex-matched control group (4 for every patient in the case group) was randomly identified from the subjects after eliminating patients who had been given a diagnosis of migraine between January 1, 2000, and December 31, 2010.

To validate the accuracy of diagnosis, we defined OAG if patients had three recorded visits with the same diagnosis code based on hospitalization or outpa- tient claims.

Results We further categorized patients with migraine and controls by ACCI scores as ACCI = 0, ACCI = 1–2, and ACCI ≥3.

The crude and adjusted HRs for patients with migraine versus the comparison group with an ACCI score of 0 were 1.73 (95% CI, 1.24–2.42) and 1.68 (95% CI, 1.20–2.36), respectively.

For patients with migraine versus comparison groups with an ACCI score of 1–2 or ACCI score ≥ 3, the adjusted HRs were not significantly different (p = .788 and p = .879, respectively).

After selecting comorbidities with a p value < 0.05 in univariate Cox regression, multivariate Cox regression analysis in all patients with migraine identified three OAG risk factors: age (adjusted HR = 1.03, 95% CI = 1.03–1.04), hyperlipidemia (adjusted HR =1.54, 95% CI = 1.16–2.05), and DM (adjusted HR =1.61, 95% CI = 1.23–2.11).

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2 Mechanisms

Discussion Due to the higher prevalence of glaucoma and higher burden of comorbidity in patients with advanced age, we used the ACCI score to quantify the disease burden of migrainous patients and non-migrainous controls in the current study.

We adjusted for age, hyperlipidemia, DM, hypertension, ischemic heart disease, peripheral vascular disease, and cerebrovascular disease, to analyze the risk for developing OAG in individuals with migraine.

The current finding was similar to that previously reported in a study utilizing the same database: the risk of POAG was not significantly higher in patients with migraine than in non-migrainous controls after adjustment for all relevant con- founding factors [510].

To the previous study, which categorized the patients into different age groups and the presence or absence of comorbidity, we evaluated patients with different ages and different levels of comorbidities simultaneously, and found that migraine was associated with a higher risk of OAG in patients without comorbidities, who were under the age of 50 years.

Conclusions Our study demonstrated the risk of developing OAG in patients with migraine in a comprehensive manner.

Acknowledgement A machine generated summary based on the work of Huang, Jehn-Yu; Su, Chien- Chia; Wang, Tsing-Hong; Tsai, I-Ju, 2019 in BMC Ophthalmology.

Relationship between migraine headache and hematological parameters