Department of Neurology, Kocaeli University Research and Application Hospital, İzmit/Kocaeli, Turkey.
Weill Cornell Medicine-Qatar, Qatar Foundation, Education City, Doha, Qatar.
Cephalalgia. 2023 May;43(5):3331024231170810. doi: 10.1177/03331024231170810.
BACKGROUND/HYPOTHESIS: Migraine affects >1 billion people but its pathophysiology remains poorly understood. Alterations in the trigeminovascular system play an important role. We have compared corneal nerve morphology in patients with migraine to healthy controls.
Sixty patients with episodic (n = 32) or chronic (n = 28) migraine and 20 age-matched healthy control subjects were studied cross-sectionally. Their migraine characteristics and signs and symptoms of dry eyes were assessed. Manual and automated quantification of corneal nerves was undertaken by corneal confocal microscopy.
In patients with migraine compared to controls, manual corneal nerve fiber density (P < 0.001), branch density (P = 0.015) and length (P < 0.001); and automated corneal nerve fiber density (P < 0.001), branch density (P < 0.001), length (P < 0.001), total branch density (P < 0.001), nerve fiber area (P < 0.001), nerve fiber width (P = 0.045) and fractal dimension (P < 0.001) were lower. Automated corneal nerve fiber density was higher in patients with episodic migraine and aura (P = 0.010); and fractal dimension (P = 0.029) was lower in patients with more headache days in the last three months. Automated corneal nerve fiber density predicted a significant amount of the observed variance in pain intensity (adjusted r = 0.14, partial r = -0.37, P = 0.004) in patients with migraine.
Corneal confocal microscopy reveals corneal nerve loss in patients with migraine. It may serve as an objective imaging biomarker of neurodegeneration in migraine.
背景/假设：偏头痛影响超过 10 亿人，但对其病理生理学仍知之甚少。三叉血管系统的改变起着重要作用。我们比较了偏头痛患者与健康对照者的角膜神经形态。
共纳入 60 例偏头痛患者（发作性偏头痛 32 例，慢性偏头痛 28 例）和 20 例年龄匹配的健康对照者。评估了他们偏头痛的特征、干眼的体征和症状。通过角膜共聚焦显微镜进行手动和自动的角膜神经量化。
与对照组相比，偏头痛患者的手动角膜神经纤维密度（P<0.001）、分支密度（P=0.015）和长度（P<0.001）；以及自动角膜神经纤维密度（P<0.001）、分支密度（P<0.001）、长度（P<0.001）、总分支密度（P<0.001）、神经纤维面积（P<0.001）、神经纤维宽度（P=0.045）和分形维数（P<0.001）均较低。发作性偏头痛伴先兆的患者自动角膜神经纤维密度较高（P=0.010）；偏头痛患者近三个月头痛天数越多，分形维数越低（P=0.029）。自动角膜神经纤维密度可以预测偏头痛患者疼痛强度的显著差异（调整 r=0.14，部分 r=-0.37，P=0.004）。
角膜共聚焦显微镜显示偏头痛患者的角膜神经缺失。它可能是偏头痛神经退行性变的客观成像生物标志物。
