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Headache Linked to Increased Prevalence of Retinopathy in Midlife

A history of migraine and other headache types has been linked to an increased prevalence of retinopathy in middle-aged individuals, supporting the hypothesis that neurovascular dysfunction underlies vascular headaches. Investigators at the University of North Carolina at Chapel Hill found that, among a biracial cohort of individuals aged 51 to 71 years, those with headache were between 1.3 and 1.5 times more likely to have retinopathy than those without headaches.

"Middle-aged people with a history of migraine and other headaches are more likely to have retinopathy," the study’s lead author Kathryn M. Rose, PhD, said in a statement from the American Academy of Neurology.

She added this association persisted even after controlling for diabetes, blood glucose levels, pack-years of smoking, average mean arterial pressure, or use of antihypertensive medications.

According to the authors, migraine has been consistently linked with stroke, but research findings into the relationship between hypertension and coronary heart disease have been inconsistent.

Furthermore, recent research has shown retinal microvascular abnormalities can predict clinical and subclinical stroke as well as other cardiovascular outcomes. "Because the retinal and cerebral microcirculations share similar anatomy, embryology, and physiology, and because neurovascular mechanisms may underlie both migraine and retinal microvascular abnormalities, an association between the two is biologically plausible," they write.

The cross-sectional study included 10,902 participants enrolled in the Atherosclerosis Risk in Communities (ARIC) Study, which was designed to investigate the etiology and natural history of atherosclerosis and its sequelae.

All study participants underwent a lifetime headache history using International Headache Society diagnostic criteria, as well as retinal photography. The mean age of the study participants was 60 years. Most (56%) were women, and 21% were African Americans. Of the total group, 40% had hypertension, 15% had diabetes, and 19% had less than a high school education. Almost 78% of the study cohort reported no history of headaches lasting 4 or more hours.

In terms of retinal outcomes, the study showed migraine was more strongly associated with retinopathy than the study’s 2 other retinal microvascular signs: focal arteriolar narrowing and arteriovenous nicking.

While individuals in all 3 headache groups were more likely to have retinopathy than those without a history of headache, the association was "modestly stronger" for individuals without hypertension or diabetes who had migraine/other headache with aura and migraines without aura.

The authors note that while retinal microvascular signs are more prevalent in the elderly and those with high blood pressure and diabetes, the study suggests they can also occur in middle-aged adults who do not have these conditions.

"The association of retinopathy with migraine in younger people independent of these factors suggests that other pathophysiologic processes not directly examined here (e.g., inflammatory factors, endothelial dysfunction) may explain these observations," they write.

The current study demonstrates that retinopathy is more common among patients with headaches vs patients without headaches. This main result was true of both patients with migraine and patients with other headaches.

Neurology. 2007;68:1694-1700.

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