Is Migraine a Risk Factor for Non-Arteritic Anterior Ischemic Optic Neuropathy? Insights from a National Case–Control Study

<b>Purpose</b>: While migraine is linked to increased cerebrovascular risk, its association with non-arteritic anterior ischemic optic neuropathy (NAION) remains underexplored. <b>Methods</b>: We conducted a retrospective case-control study using population-based electronic medical records. NAION patients were compared to propensity score-matched controls regarding migraine prevalence and clinical characteristics. <b>Results</b>: From 2001 to 2022, among 6,566,619 patients, 1629 NAION cases (mean age 67 ± 13 years; 45% female) and 6433 propensity matched controls were identified. The prevalence of migraine was similar in both groups (3.8% vs. 3.3%, <i>p</i> = 0.3). Among migraine patients, those with NAION (n = 62, age 62 ± 11) and controls (n = 212, age 60 ± 11) had comparable baseline characteristics, except for congestive heart failure (9.7% vs. 2.4%, <i>p</i> = 0.027). Within the NAION cohort, migraineurs (n = 64) were younger (62 ± 12 vs. 67 ± 13 years, <i>p</i> < 0.001), and had lower rates of diabetes mellitus (35% vs. 57%, <i>p</i> < 0.001) and peripheral vascular disease (1.6% vs. 9.6%, <i>p</i> = 0.03). Female migraineurs developed NAION at a younger age than females without migraine (60 ± 12 vs. 69 ± 12 years, <i>p</i> < 0.001); no such difference was seen in males. Multinomial logistic regression revealed that migraine was independently associated with younger age at NAION onset, particularly in patients aged <59 (OR = 5.8, <i>p</i> = 0.001) compared with those >70. An independent 1:4 migraine to non-migraine matched cohort (n = 310) showed similar age-dependent trends. <b>Conclusions</b>: While migraine was not more prevalent among NAION patients, females with migraine developed NAION at a younger age and had fewer vascular comorbidities. Congestive heart failure was more prevalent among migraine patients who developed NAION, suggesting a potential contributory role of systemic hypoperfusion.