Study Finds Strong Association Between Dry Eye Disease and Migraines

Patients with migraine headaches could be at risk for a comorbid diagnosis of dry eye disease—despite the fact that these 2 diseases seem unrelated, according to a new report.

Investigators from the University of North Carolina (UNC) Chapel Hill conducted a retrospective case-control study including 72,969 patients in order to determine whether there was an association between dry eye disease and migraine headaches. The patients were all over 18 years of age and treated at UNC affiliated health care facilities between May 2008 and May 2018. There were 41,764 men (57%) and 31,205 women (42%) involved in the study.

The study authors said that the published literature on the topic has conflicting reports about any association between dry eye disease and migraines, so they calculated data based on their study participants as a whole, as well as classified by sex and age groups.

The investigators learned that 5352 patients (7.3%) carried a diagnosis for migraine headache while 9638 (13.2%) had a dry eye disease diagnosis.

They reported that the odds of having dry eye disease with a diagnosis of migraine headaches was 1.72 times higher than that of patients without migraine headaches, once the investigators took age and sex into consideration. This accounted for a 20% higher risk of dry eye disease diagnosis with migraine headache diagnosis compared to individuals without a diagnosis of migraine headaches, they said.

Before accounting for any confounding factors, it appeared that men aged between 55-64 years and women of all ages exhibited odds ratios between migraine headaches and dry eye disease that suggested a link between both diseases. Some of the confounding factors included use of specific medications (such as tricyclic antidepressants, antihistamines, or diuretics), a history of rheumatoid arthritis, Sjogren disease, or lupus.

Additionally, after taking those confounding factors into account, the investigators said that men and women aged 65 and older demonstrated odds ratios suggesting a link between both diseases.

“We were surprised to find such a relatively strong association between two seemingly unrelated diseases,” study author Omar Ismail, an MD candidate, told MD Magazine®. “Migraine headaches and DED are driven by underlying inflammatory processes.”

Ismail explained that both disorders share a common inflammatory component that makes the presence of DED more prevalent in patients with a history of migraines.

“Furthermore, the trigeminal ganglion also plays an important role in the pathogenesis of both DED and migraine headaches,” he said. “It is possible that this structure could account for the potential relationship between these 2 disorders.”

Older age and female sex are both risk factors for dry eye disease development risk, which results from hormonal and age-related changes, investigators observed. Plus, migraine headaches are more common in women than men. This factors into the “logically consistent” findings in prior literature that supports their claims, the study authors wrote.

“Physicians caring for patients with a history of migraines should make sure to question these individuals about whether they experience ocular symptoms commonly associated with dry eye disease (e.g., dryness, burning, a sensation of grittiness),” Ismail said. “Patients suffering from such symptoms may benefit from referral to an ophthalmologist.”

The study, “Association Between Dry Eye Disease and Migraine Headaches in a Large Population-Based Study,” was published online in JAMA Ophthalmology.