13. Headache Disorders

Question 1

Do migraines affect the refractive error, pupils and BV?

Answer 1

• Refractive error → there are little to no evidence that refractive error is affect
• Pupils → there are case reports of episodic pupil anomalies with migraine attacks
• May impact binocular vision problems e.g. eye strain/ asthenopia

Question 2

Migraines contribute to ... which may contribute to ... in susceptible individuals. There is a ... of migraine in people with glaucoma, especially those with ... and .... Migraines is also one of the strongest predictors of ... progression in ....

Answer 2

Migraines contribute to vasospastic tendencies which may contribute to glaucoma in susceptible individuals. There is a higher prevalence of migraine in people with glaucoma, especially those with normal tension glaucoma (NTG) and familial glaucoma. Migraines is also one of the strongest predictors of visual field progression in NTG.

Question 3

Interictal visual field defects are ... visual field loss in between ... in people without .... These losses are similar to px with .... However these losses .... This is found to be highly dependent on an individual’s ... cycle. The field defects can also become worse .... Most of these losses are ... and/ or .... Around ...% of people have visual field defects with ... but no glaucoma.

Answer 3

Interictal visual field defects are monocular visual field loss in between attacks in people without glaucoma. These losses are similar to px with glaucoma. However these losses resolve over time. This is found to be highly dependent on an individual’s migraine cycle. The field defects can also become worse closer to an attack. Most of these losses are unilateral and/ or non-homonymous. Around 4% of people have visual field defects with migraine but no glaucoma.

Question 4

How may migraines affect visual field testings?

Answer 4

People with migraine may have an increased variabiltiy in their visual fields, therefore making it harder to diagnose other diseases if present = increased test-retest variability.

Question 5

How may migraines affect OCT testings?

Answer 5

In between migraines, individuals appear to have a temporary reduction in retinal nerve fibre layer, which is similar to that of glaucoma (but permanent). This may make is harder to diagnose true glaucoma. Optoms should therefore follow up with individuals and determine px’s baseline parameters.

Question 6

What were the limitations of the migraine eye/ vision studies?

Answer 6

There are only cross-sectional studies available, therefore cannot show casual effects of migraine attacks. Difficult to compare/ combine studies as there are no consistent protocols/ technology for acquisition and analysis. Not all studies collect the same demographic/ migraine data.

Question 7

Tips for working with px with migraines:
* Make note of ... in px record
* Consider baseline ... for future reference as migraine may increase risk of ...
* Don’t include people with ... in normative databases
* Note time of VF testing relative to a ... (and if any ... taken)
* OCT and VF results may be abnormal, so check ... carefully. If suspect glaucoma, could supplement with ... (ERF and VEP)

Answer 7

Tips for working with px with migraines:
* Make note of migraine hx in px record
* Consider baseline VF testing for future reference as migraine may increase risk of glaucoma
* Don’t include people with active migraine in normative databases
* Note time of VF testing relative to a migraine (and if any medications taken)
* OCT and VF results may be abnormal, so check optic nerve carefully. If suspect glaucoma, could supplement with electrophysiology (ERF and VEP)