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Risk of Retinal Artery Occlusion in Patients with Migraine

  • Ahmad Al-Moujahed
    Affiliations
    Department of Ophthalmology, Byers Eye Institute, Horngren Family Vitreoretinal Center, Stanford University School of Medicine, Palo Alto, California, USA
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  • Elaine M. Tran
    Affiliations
    Department of Ophthalmology, Byers Eye Institute, Horngren Family Vitreoretinal Center, Stanford University School of Medicine, Palo Alto, California, USA
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  • Amee Azad
    Affiliations
    Department of Ophthalmology, Byers Eye Institute, Horngren Family Vitreoretinal Center, Stanford University School of Medicine, Palo Alto, California, USA
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  • Daniel Vail
    Affiliations
    Department of Ophthalmology, Byers Eye Institute, Horngren Family Vitreoretinal Center, Stanford University School of Medicine, Palo Alto, California, USA
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  • Cassie A. Ludwig
    Affiliations
    Department of Ophthalmology, Byers Eye Institute, Horngren Family Vitreoretinal Center, Stanford University School of Medicine, Palo Alto, California, USA
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  • Malini Veerappan Pasricha
    Affiliations
    Department of Ophthalmology, Byers Eye Institute, Horngren Family Vitreoretinal Center, Stanford University School of Medicine, Palo Alto, California, USA
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  • Tatiana R. Rosenblatt
    Affiliations
    Department of Ophthalmology, Byers Eye Institute, Horngren Family Vitreoretinal Center, Stanford University School of Medicine, Palo Alto, California, USA
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  • Natalia F. Callaway
    Affiliations
    Department of Ophthalmology, Byers Eye Institute, Horngren Family Vitreoretinal Center, Stanford University School of Medicine, Palo Alto, California, USA
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  • Darius M. Moshfeghi
    Correspondence
    Inquiries to Darius M. Moshfeghi, Professor and Chief of Retina Division, Byers Eye Institute, Department of Ophthalmology, Stanford University School of Medicine, 2452 Watson Ct, Ste 2200, Palo Alto, CA 94305, USA
    Affiliations
    Department of Ophthalmology, Byers Eye Institute, Horngren Family Vitreoretinal Center, Stanford University School of Medicine, Palo Alto, California, USA
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Published:December 24, 2020DOI:https://doi.org/10.1016/j.ajo.2020.11.004

      Highlights

      • This is the first large study to show that migraine is associated with increased risk of a central, branch, and other types of retinal artery occlusion (RAO) after adjusting for all known risk factors of RAO.

      Purpose

      We sought to determine if migraine is associated with increased risk of retinal artery occlusion (RAO).

      Design

      Retrospective cohort study.

      Methods

      We reviewed a large insurance claims database for patients with migraine and matched control subjects without migraine between 2007 and 2016. Cox proportional hazard regression models were used to investigate the association between migraine and risk of all RAO, central RAO (CRAO), branch RAO (BRAO), and “other” RAO, which includes transient and partial RAO. Primary outcome measures included the incidence of all RAO, including CRAO, BRAO, and other RAO, after first migraine diagnosis.

      Result

      There were 418,965 patients with migraine who met the study criteria and were included in the analysis with the appropriate matched control subjects. Among the 418,965 patients with migraine, 1060 (0.25%) were subsequently diagnosed with RAO, whereas only 335 (0.08%) of the patients without migraine were diagnosed with RAO. The hazard ratio (HR) for incident all RAO in patients with migraine compared with those without migraine was 3.48 (95% confidence interval [CI] 3.07-3.94; P < .0001). This association was consistent across all types of RAO, including CRAO (HR 1.62 [95% CI 1.15-2.28]; P = .004), BRAO (HR 2.09 [95% CI 1.60-2.72]; P < .001), and other types of RAO (HR 4.61 [95% CI 3.94-5.38]; P < .001). Patients with migraine with aura had a higher risk for incident RAO compared with those with migraine without aura (HR 1.58 [95% CI 1.40-1.79]; P < .001). This association was consistent for BRAO (HR 1.43 [95% CI 1.04-1.97]; P < .03) and other types of RAO (HR 1.67 [95% CI 1.45-1.91]; P < .001) but was not statistically significant for CRAO (HR 1.18 [95% CI 0.75-1.87]; P = .475). Significant risk factors for this association included increased age, male sex, acute coronary syndrome, valvular disease, carotid disease, hyperlipidemia, hypertension, retinal vasculitis or inflammation, and systemic lupus erythematosus.

      Conclusions

      Migraine is associated with increased risk of all types of RAO and migraine with aura is associated with increased risk of RAO compared with migraine without aura.
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