Migraine and Low-Tension Glaucoma

The authors administered a standardized headache questionnaire to 54 patients with low-tension glaucoma, 182 patients with primary open-angle glaucoma, 126 patients with ocular hypertension, and 493 normal subjects. Patients with low-tension glaucoma had headaches with or without features of migraine (unilateral headache, nausea or vomiting, or visual prodromata) more frequently than did any of the other groups. The higher prevalence of headache in low-tension glaucoma patients, who were usually elderly, was especially striking when their age was considered, since headaches are less common in elderly normal subjects than in young normal subjects. Headaches were present in 86% of elderly low-tension glaucoma patients (70 yr of age or older) but in only 64% of elderly normal subjects (P = 0.04) and only 59% of elderly ocular hypertensive patients (P = 0.02). Because migraine is an ischemic disorder, its possible association with low-tension glaucoma has etiologic and therapeutic implications. Invest Ophthalmol Vis Sci 26:1105-1108, 1985 In an earlier study, we examined 27 patients with low-tension glaucoma looking for evidence of neu- rologic dysfunction. 1 Although no abnormalities were consistently found by neurologic examination, neu- robehavioral testing, computerized axial tomography of the head, or electroencephalography, in 12 of the patients we elicited a history of migraine. We found this unanticipated finding of interest because migraine is associated with decreased cerebral blood flow, 2 " 5 and attacks of migraine have been reported to cause ischemic infarctions of the brain, 6 ' 7 determine the prevalence of migraine. It was not until we were well into the study that we realized how frequently patients were giving us such a history. In the present study, we used a standardized ques- tionnaire to determine the prevalence of headache and associated migraine symptoms in patients with low-tension glaucoma. We also determined the prev- alence of these symptoms in several other groups of patients: normal subjects without eye disease, patients with ocular hypertension, patients with primary open- angle glaucoma, and patients attending the eye clinic for treatment of other ocular disorders. We could use a questionnaire for this case-control study because the diagnosis of migraine is made solely by history. The disorder has no physical signs or laboratory abnormalities. The major symptom of migraine is episodic headache, which is often unilat- eral, often preceded by visual prodromata, and often accompanied by nausea or vomiting.