Retroorbital pain and autonomic dysfunctions in patients with migraine

Abstract

Background. A part of migraine patients complain of unilateral or bilateral ocular pain during migraine access, which may be associated with some vegetative disorders: ptosis, mydriasis, conjunctival congestion, photo and phonophobia, lacrimation, unvoluntary periorbital muscle contractions, nasal hypersecretion. It is important to analyze the frequency of ocular pain in patients with migraine, laterality, character and their association with other autonomic manifestations. Material and methods: 91 patients with migraine (9.9% men, 90.1% women), out of them 51.6% with chronic migraine, 34.1% with episodic migraine and 14.3% with rare episodic migraine. Patients’ age was 18-63 years. The study included only patients with migraine without other associated neurological or ocular pathology. Ophthalmologic examination included assessment of visual acuity, perimetry, intraocular pressure measurement in migraine crisis and lucid period (air-push N 10-21 mm Hg), ophthalmoscopy, biomicroscopy, refractometry if necessary. Results: According to the statistical analysis of data, 48.4% patients had bilateral ocular pain during migraine attack; 26.3% unilateral headache and eye pain, 25.3% did not experience pain during the migraine attack. By the type of eye pain 34.1% had non-pulsating retro-orbital pain; 18.7% –pulsating retroorbital pain; 22% - had superficial eye pain. During the migraine attack 18.7% of migraine patients had unilateral conjunctival congestion, ipsilateral of headache; 33% bilateral congestion and congestion absent in 48.4% patients. Unilateral lacrimation – 11.4%, bilateral lacrimation in – 25.6%. Photophobia between attacks of migraine accounted for 38.6% of patients. Unilateral ptosis – 8.4% during the attack, bilateral ptosis – 10.8%. Periorbital muscle tics during the migraine attacks were observed in 42.2% patients. We found a statistically significant correlation (P <0.001) between the type of eye pain and intraocular pressure values measured during the migraine attacks and between them. Conclusions: Migraine attacks are often associated with different character of ocular pain, autonomic disorders and with increasing of intraocular pressure.