Migraine is typically defined as a headache without a cause. It is, however, often accompanied by uncomfortable eye related symptoms. Diseases of the ocular surface can exacerbate migraine headaches. In fact, migraines can trigger symptoms of dry eye, pain behind the eyeball (retroorbital pain), visual hallucinations, light sensitivity, and even decreased vision. This article explores the relationship between migraine and the eye.
Migraine and Eye Related Symptoms
Eye related symptoms of migraine can be present with or without the headache, and can occur before, during, or after the migraine. The most common symptoms include photophobia, eye pain and ‘aura”.
Photophobia
Almost 90% of migraine patients complain of light sensitivity, and feel better in a dark room. In fact, bright light is often a trigger for migraines.
Visual aura
Almost 25% of migraine patients experience vision related symptoms that range from flashing lights, haloes, wavy lines, blind spots, and even temporary loss of vision. As mentioned earlier, these can be before, during, or after, or even without the headache.
Pain and discomfort of the eye
Patients often experience pain and pressure behind the eyes (called retroorbital pain). Patients also complain of dryness, burning, irritation, and watering of the eyes. These are often associated with ocular surface diseases, including dry eye, meibomian gland disease and allergic conjunctivitis. Migraine, and interestingly, sometimes its treatment, is known to exacerbate the signs of OSD, just as OSD may trigger migraines. In fact, this may become a vicious cycle, in which either condition continues to trigger the other.
Neurological Link Between Migraine and the Eyes
Trigeminal system
The trigeminal nerve innervates the eye including the cornea, and the brain including its outer covering called the dura mater. Any abnormal activity of the trigeminal nerve, therefore, causes the headache, along with eye pain and light sensitivity.
Autonomic nervous system
The trigeminal pathway is also integrated with the autonomic nervous system (ANS). This explains the drooping of eye lids, red eyes, and watering, along with pupil changes in some patients of migraine.
Migraine Management
The treatment of migraine and eye related symptoms has three components. These include:
- Abortive treatments after the headache starts;
- Preventive therapy to decrease the frequency, intensity, and duration of the headache and associated symptoms;
- Lifestyle changes to reduce migraine triggers, and perpetuating factors
Your neurologist will take care of your migraine, while this is how your eye doctor can help you manage the headaches better.
- Ensure that your power of glasses is correct.
- Your doctor will treat any underlying ocular surface diseases, including dry eye, meibomian gland disease and allergic conjunctivitis. This will eliminate at least one potent migraine trigger.
- Rule out angle closure disease, which may precipitate migraine like headaches.
- Sometimes, migraine medication can result in some eye related symptoms. Your eye doctor can manage this better.
