The association between migraine and glaucoma diseases: A retrospective cohort study

Migraine and glaucoma represent substantial public health concerns. Previous epidemiological studies on their direct association have yielded inconsistent findings, though shared pathophysiological mechanisms are proposed. This large, population-based cohort study aimed to explore the migraine-glaucoma association, assessing glaucoma prevalence, clinical presentation, and disease severity markers in patients with migraine compared to nonmigraine controls.

This retrospective cohort study, conducted in southern Israel using data from Clalit Health Services and Soroka University Medical Center, used medical records from 2000 to 2023. Adult patients with migraine (identified by ICD-9 codes/triptan claims) were matched with nonmigraine controls. The primary outcome was ophthalmologist-diagnosed glaucoma (ICD-9 code, ≥1 intraocular pressure measurement). We evaluated the association between migraine and glaucoma risk using adjusted models and compared the time to glaucoma diagnosis between groups. In the glaucoma subcohort, we compared clinical outcomes, treatment patterns, and time to first surgical intervention between migraine and nonmigraine groups.

The cohort included 83,758 individuals (30,733 migraine, 53,025 controls). Patients with migraine had lower glaucoma diagnosis-free survival (p < 0.001) and a 31% higher relative risk of glaucoma diagnosis (adjusted relative risk = 1.31; 95% confidence interval, 1.15-1.48; p < 0.001). In the glaucoma subcohort (n = 2306), patients with migraine had earlier and more frequent ophthalmic surveillance (p < 0.001). These patients also showed lower use of topical hypotensive medications (p = 0.058) and a lower hazard of glaucoma surgery (adjusted hazard ratio = 0.66; 95% confidence interval, 0.43-1.00; p = 0.047).

This population-based study provides evidence for an association between migraine and an increased risk of glaucoma. Although increased ophthalmologic surveillance among patients with migraine likely contributes to earlier diagnosis and detection of milder cases, shared biological mechanisms may also play a role. Furthermore, patients with migraine and glaucoma demonstrated lower medication use and fewer surgical interventions, potentially indicating a less severe disease course.