Evaluation of migraine patients with optical coherence tomography angiography

DOI: https://doi.org/10.1007/s10792- 021- 01962- 3

Abstract-Summary To compare optical coherence tomography angiography (OCTA) findings in cases with migraine and healthy controls.

Thirty-eight eyes of 19 patients with migraine with aura and 38 eyes of 19 healthy

subjects were enrolled in this prospective and comparative study.

The optic disc rim area was significantly larger in the migraine group compared

to the control group (p  =  0.009).

In OCTA measurements, the FAZ area was significantly larger in migraine

patients (p =  0.001).

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3 Diagnosis

The parafoveal superficial VD measurements were found to be lower in the

migraine patients in all quadrants, but not statistically significant.

Migraine with aura was associated with optic disc rim changes, but without any

remarkable foveal vascular decrements.

Extended: The parafoveal superficial VD measurements were higher in the con- trol group in all four quadrants, but not statistically significant (p values for the superior, inferior, temporal and nasal quadrants 0.358, 0.390, 0.551 and 0.135, respectively).

Future studies will be supportive to determine the significance of OCTA in the

management of migraine patients.

Introduction Several hypotheses have been proposed about the pathogenesis of migraine, such as inherited alteration of brain excitability, intracranial arterial dilatation, recurrent activation and sensitization of the trigeminovascular pathway, and consequent struc- tural and functional changes in genetically susceptible individuals [388–390].

Migraine episodes lead to the activation and sensitization of the trigeminal vas-

cular system (TGVS).

Migraine is a risk factor for ischaemic complications of the retina and optic nerve, such as ischaemic optic neuropathy and retinal artery and vein occlusions [391–395].

Ganglion cell death due to an alteration in the perfusion of the optic nerve head

or the retina has been suggested in migraine patients [396].

There are several studies that have evaluated retinal nerve fibre layer (RNFL)

thickness differences in migraine patients [396–398].

We aimed to study retinal VD and RNFL thickness changes in migraine patients

and healthy subjects.

Material and Methods The subjects were divided into two groups: normal cases (control group) and migraine with aura having at least one visual symptom (study group).

The study group comprised subjects older than 18 years old who were followed up in the Neuro-ophthalmology Department and had a migraine attack with aura within the last two weeks.

Slit lamp biomicroscopy, fundus examination, intraocular pressure (IOP) by air- puff tonometry, swept-source optic coherence tomography (SS-OCT) and OCTA scans were performed.

All eyes were imaged with a Triton SS-OCT device (Topcon®, Tokyo, Japan) by

the same experienced examiner.

The temporal, inferior, nasal and superior sectors of the parafoveal ring were

compared with the normal group, excluding the central ring.

The normality of the variables was assessed using the Shapiro–Wilk test. For more than two groups, the Kruskal–Wallis test was applied for normally

distributed variables.

3.4 Neuroimaging

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Results There were no statistically significant differences between migraine patients and control eyes in terms of age and sex (p = 1.000 and p = 0.958, respectively).

The optic disc rim area was significantly larger in the migraine group compared

with the control group (p = 0.009).

In macular OCTA measurements, the FAZ area was 0.326  ±  0.065  mm2 in migraine patients, significantly larger than the control group (0.272 ± 0.070 mm2, p = 0.001).

The parafoveal superficial VD measurements were higher in the control group in all four quadrants, but not statistically significant (p values for the superior, inferior, temporal and nasal quadrants 0.358, 0.390, 0.551 and 0.135, respectively).

Discussion We found a larger FAZ and optic disc rim area in migraine patients.

A study by Chang and others showed a significantly enlarged FAZ area and

reduced superficial foveal VD in migraine patients.

Ulusoy and others [399] reported a thinner average RNFL thickness and a larger

FAZ area in migraine patients.

They also indicated that deep foveal VD and average RNFL were significantly in patients with migraine with aura having brain white matter

lower hyperintensities.

A meta-analysis by Feng and others [400] described a significant reduction in

average RNFL thickness in patients with migraine.

Similar to our findings, Tan and others [401] detected no significant difference in

the RNFL thickness of migraine patients.

We found a larger optic disc rim area in patients with migraine with aura.

Acknowledgement A machine generated summary based on the work of Hamurcu, Mualla S.; Gultekin, Burcu P.; Koca, Semra; Ece, Seyma D. 2021 in International Ophthalmology

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