Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, Salt Lake City, UT, USA.
Department of Neurology, University of Utah, Salt Lake City, UT, USA.
Headache. 2018 Jul;58(7):1007-1013. doi: 10.1111/head.13330. Epub 2018 Jun 7.
Migraine is associated with several important visual symptoms, during both acute attacks and headache-free intervals. The purpose of this investigation was to use validated vision-related quality of life instruments to assess the effect of migraine on visual quality of life.
Many migraineurs experience visual aura, increased photophobia during and between headache attacks, and increased symptoms of dry eye with structural changes in corneal nerve endings. Other visual symptoms associated with migraine include positive persistent visual phenomenon (visual snow) and transient vision changes. Previous research looking at the disability associated with migraine has shown that patient-reported quality of life data can be useful in determining the severity of disease burden. Recent published literature has suggested that visual symptoms related to migraine represent a proportionally minor burden to patients, compared to other manifestations of migraine, but no previous studies have assessed how migraine affects visual quality of life.
In this cross-sectional quantitative survey, visual quality of life in individuals with chronic and episodic migraine was assessed using the National Eye Institute Visual Function Questionnaire-25, and the 10-item National Eye Institute Visual Function Questionnaire-25 Neuro-Ophthalmic Supplement. Overall headache severity and impact was assessed using the Migraine-specific Quality of Life Questionnaire (Version 2.1) and the Headache Impact Test-6. Participants were recruited from Headache and Neuro-ophthalmology subspecialty clinics. The target sample size was 30 participants per subgroup. The results were compared to those from disease-free controls and to results from other neuro-ophthalmic disease quality of life studies.
Among 29 participants with chronic migraine, vision-specific quality of life scores were all statistically significantly decreased compared to disease-free controls. The National Eye Institute Visual Function Questionnaire-25 median composite score was 85 for chronic migraineurs and 96 for controls (P < .001). The 10-item National Eye Institute Visual Function Questionnaire-25 Neuro-Ophthalmic Supplement median score was 72 for chronic migraineurs and 95 for controls (P < .001). Among 37 participants with episodic migraine, vision-specific quality of life scores were also decreased compared to disease-free controls. In the episodic migraine group, decreases in the National Eye Institute Visual Function Questionnaire-25 scores were not statistically significant (median score 91, P = .01 compared to the control group), but decreases in the 10-item National Eye Institute Visual Function Questionnaire-25 Neuro-Ophthalmic Supplement remained statistically significant (median score 85, P = .003 compared to the control group). Chronic migraineurs had decreased visual quality of life scores compared to those with episodic migraines. Participants with chronic migraine had visual quality of life scores that were as poor as those previously published for patients with other neuro-ophthalmic disorders such as multiple sclerosis, myasthenia gravis, and ischemic optic neuropathy.
Visual quality of life is significantly adversely affected in migraine sufferers. In fact, patients with chronic migraine may have visual quality of life impacts that are as significant as those associated with other common neuro-ophthalmic disorders. Future studies of the overall disease burden in patients with migraine should include an evaluation of the effects on visual functioning.
偏头痛与多种重要的视觉症状有关，包括急性发作期间和头痛发作间期。本研究旨在使用经过验证的与视觉相关的生活质量工具评估偏头痛对视觉生活质量的影响。
许多偏头痛患者会出现视觉先兆、在头痛发作期间和发作间期畏光增加，以及角膜神经末梢结构改变导致干眼症症状加重。其他与偏头痛相关的视觉症状包括持续性阳性视觉现象（视觉雪）和短暂的视觉变化。以前研究偏头痛相关残疾的研究表明，患者报告的生活质量数据可用于确定疾病负担的严重程度。最近发表的文献表明，与偏头痛相关的视觉症状对患者的影响相对较小，与偏头痛的其他表现相比，但以前的研究尚未评估偏头痛如何影响视觉生活质量。
在这项横断面定量调查中，使用国家眼科研究所视觉功能问卷-25 版和 10 项国家眼科研究所视觉功能问卷-25 神经眼科补充问卷评估慢性和发作性偏头痛患者的视觉生活质量。使用偏头痛特异性生活质量问卷（第 2.1 版）和头痛影响测试-6 评估总体头痛严重程度和影响。参与者从头痛和神经眼科亚专科诊所招募。目标样本量为每个亚组 30 名参与者。将结果与无疾病对照组和其他神经眼科疾病生活质量研究的结果进行比较。
在 29 名慢性偏头痛患者中，与无疾病对照组相比，所有视觉特异性生活质量评分均显著降低。国家眼科研究所视觉功能问卷-25 综合评分中位数为慢性偏头痛患者 85 分，对照组 96 分（P<0.001）。国家眼科研究所视觉功能问卷-25 神经眼科补充评分中位数为慢性偏头痛患者 72 分，对照组 95 分（P<0.001）。在 37 名发作性偏头痛患者中，与无疾病对照组相比，视觉特异性生活质量评分也降低。在发作性偏头痛组中，国家眼科研究所视觉功能问卷-25 评分的下降无统计学意义（中位数评分 91，与对照组相比 P=0.01），但国家眼科研究所视觉功能问卷-25 神经眼科补充评分的下降仍具有统计学意义（中位数评分 85，与对照组相比 P=0.003）。慢性偏头痛患者的视觉生活质量评分低于发作性偏头痛患者。慢性偏头痛患者的视觉生活质量评分与以前发表的其他常见神经眼科疾病（如多发性硬化症、重症肌无力和缺血性视神经病变）患者的视觉生活质量评分一样差。未来对偏头痛患者整体疾病负担的研究应包括对视觉功能影响的评估。
