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The optometric correlates of migraine

Harle, D. E. (2007). The optometric correlates of migraine. (Unpublished Doctoral thesis, City, University of London)


The role of the optometric factors in migraine headache is still controversial. The aim of this thesis was to investigate the optometric correlates of migraine. Following a detailed literature review a wide-ranging study of the optometric correlates of migraine is described.

This study showed that in people with migraine, pupil responses associated with both sympathetic and parasympathetic autonomic nervous system changes are altered in the interictal phase of migraine. This indicates an effect of migraine on the autonomic nervous system between migraine attacks. Low degrees of astigmatism were more common in people with migraine, and the most significant finding was the horizontal component. Subtle binocular vision anomalies and reduced stereoacuity were also detected in people with migraine.

It was shown that visual fields remain unaltered in migraine, increasing our understanding on how and where in the visual pathway deficits in migraine may occur. A second cohort of patients was recruited to investigate this area more fully. Using visual field and optical coherence tomography data this second, complimentary study, confirmed that visual fields measurements and retinal nerve fibre layer measurements are unaltered in relatively young people with migraine.

It was found that pattern glare is a correlate of migraine and that migraine is associated with visual triggers such as light sensitivity, aversive patterns and other visual stimuli. A factor analysis was used to investigate the interaction between these visual triggers. This revealed two aspects of pattern glare; the overall number of illusions seen in striped patterns was associated with visual triggers whilst pattern glare, use of coloured filters and interictal light sensitivity together formed a component interpreted as visual stress.

It is possible that some of the optometric correlates of migraine identified might play a causal role in some migraine episodes. This hypothesis was investigated using seven single subject double-masked placebo controlled trials. Spectacle lenses to correct astigmatic refractive error, prism spectacles to correct for subtle binocular vision anomalies and precision tinted lenses to reduce pattern glare were amongst the interventions assessed. In two individuals, prism spectacles relieved some migraine symptoms. However neither precision tinted spectacles nor the correction of refractive errors influenced migraine factors in those individuals assessed.

In conclusion, there are distinct optometric correlates of migraine and visual triggers of migraine are important. Relieving optometric conditions in people with migraine may reduce co-morbid ocular disorders but may not alter migraine head pains.

Publication Type: Thesis (Doctoral)
Subjects: R Medicine > RE Ophthalmology
R Medicine > RZ Other systems of medicine
Departments: School of Health & Psychological Sciences > Optometry & Visual Sciences
School of Health & Psychological Sciences > School of Health & Psychological Sciences Doctoral Theses
Doctoral Theses
[thumbnail of Harle thesis 2007 PDF-A.pdf]
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