A Cross-Sectional Analytical Study of Retinal Microvascular Changes in Migraine Patients in a Tertiary Care Center

Background: Migraine is a complex neurological disorder characterized by recurring headache, with distinct phases. Neurovascular dysfunction and hypothalamic activation are pathophysiological mechanisms of migraine. Cerebral microvascular damage has been implicated in migraine. As cerebral and retinal microvasculature share similar embryology, anatomy and physiology, changes in retinal microvasculature may mirror changes in cerebral microvasculature. This study was aimed to look into the retinal microvascular abnormalities in migraine patients. Objective: This study aims to look into the relationship between migraine and retinal microvascular abnormalities and to compare the results between groups of migraine with aura, migraine without aura, and non-migraine headaches. Methods: This cross-sectional analytical study included 312 patients with primary headaches after ruling out secondary causes at Tirunelveli Medical College Hospital (TVMCH) between August 2021 and December 2022. A semi structured interview was done with each participant to gather clinical information about their headache characteristics using ICHD 3 criteria and classified headache patients in to migraine with aura, migraine without aura and non-migraine headaches groups. Retinal microvascular abnormalities were evaluated using fundus photographs from an indirect ophthalmoscope. Retinal microvascular abnormalities recorded includes retinopathy, focal arteriolar narrowing, and arteriovenous nicking. Results: Of the 312 patients, 82 presented had migraine with aura, 118 had migraine without aura, and 112 had non migraine headache. Female patients were affected in both migraine groups. Retinopathy was observed in 52 patients of migraine with aura group, 12 patients of migraine without aura group, and 8 patients of non-migraine headache group. Focal arterial narrowing was noted in 68 patients of migraine with aura, 16 patients of migraine without aura, and 10 patients of non-migraine headache. Focal arteriolar narrowing and arteriovenous nicking were more in patients of migraine with aura. Statistical analysis revealed a significant association between migraine aura and retinal abnormalities (p = 0.0027). Conclusion: Migraine is associated with retinal microvascular abnormalities, including retinopathy, focal arteriolar narrowing, and arteriovenous nicking. Migraine with aura is more associated with retinal microvascular abnormalities compared to migraine without aura and non-migraine headaches.