Migraine as a risk factor for retinal vascular events and maculopathies: a systematic review and meta-analysis of 47 million individuals

Migraine is increasingly recognized as a systemic disorder associated with cerebrovascular disease, endothelial dysfunction, and microvascular retinal changes. Given shared features between the retina and cerebral circulation, retinal vascular events (RVEs) and maculopathies may represent additional vascular manifestations of migraine. We aim to meta-analyze evidence on RVE and maculopathy risk in migraine. We conducted a PRISMA-compliant systematic review and meta-analysis (PROSPERO: CRD420251250431). Web of Science, PubMed, Scopus, and meeting abstracts were searched through January 2026, without language or date restrictions. Observational studies comparing the risk of RVEs or maculopathies in migraineurs versus non-migraineurs were included. Random-effects meta-analyses were performed using pooled risk ratios (RRs) from best adjusted analyses with 95% confidence intervals (CIs). Study quality was assessed using the Newcastle–Ottawa Scale. Thirteen studies encompassing 47,042,175 individuals met the inclusion criteria. An adjusted analysis suggested migraine was associated with a significantly increased risk of any RVE (RR 2.04, 95% CI 1.53–2.72). Migraineurs demonstrated elevated risks of any RAO (RR 2.12, 95% CI 1.25–3.60), central RAO (RR 1.62, 95% CI 1.14–2.30), and branch RAO (RR 1.94, 95% CI 1.57–2.40). Similarly, the risk of any RVO was increased (RR 1.72, 95% CI 1.44–2.04), including central and branch forms. Migraine with aura conferred a higher arterial occlusion risk compared to migraine without aura in two studies. Evidence on the protective effects of therapies remains inconclusive. Three studies suggest associations with neovascular age-related macular degeneration and central serous chorioretinopathy. Ten studies were rated as good according to the AHRQ standards. Migraine is associated with a significantly increased risk of retinal arterial and venous occlusive events, yet current literature is limited by miscoding from administrative database studies. Evidence on increased maculopathy risk in migraine remains elusive. These results support heightened awareness of retinal vascular complications in migraineurs and proactive ocular monitoring, particularly those with aura. Past links implying higher stroke risk following RAO, combined with migraine’s established association with stroke, hint at the need for primary stroke prevention in migraineurs with RAO. Prospective studies to clarify causality and the impact of migraine therapies - particularly anti-CGRPs - on retinal vascular risk are warranted.