Corneal confocal microscopy identifies corneal nerve fiber loss in patients with migraine

Author:

Guldiken Yigit Can1,Petropoulos Ioannis N2,Malik Ayesha2,Malik Rayaz A2,Yüksel Refref3,Budak Faik1,Selekler Hamit Macit1

Affiliation:

1. Department of Neurology, Kocaeli University Research and Application Hospital, İzmit/Kocaeli, Turkey

2. Weill Cornell Medicine-Qatar, Qatar Foundation, Education City, Doha, Qatar

3. Department of Ophthalmology, Kocaeli University Research and Application Hospital, İzmit/Kocaeli, Turkey

Abstract

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. Methods 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. Results 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 r2 = 0.14, partial r = −0.37, P = 0.004) in patients with migraine. Conclusions Corneal confocal microscopy reveals corneal nerve loss in patients with migraine. It may serve as an objective imaging biomarker of neurodegeneration in migraine.

Publisher

SAGE Publications

Subject

Neurology (clinical),General Medicine

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