Headache and the eye

Risk Factors and Characteristics Associated with Visual Impairment and Eye Diseases in Moyamoya Disease: Insights from a National Database

INTRODUCTION

This study aims to investigate the incidence and risk factors of visual impairment and eye diseases in patients with moyamoya disease (MMD), a rare cerebrovascular disorder. Understanding these associations is crucial for improving patient management and outcomes.

METHODS

This study utilized International Classification of Diseases (ICD) codes from both the 9th edition (ICD-9-CM) and 10th edition (ICD-10-CM) to define diagnoses, complications, and procedures within the National Inpatient Sample (NIS) Database. Data elements were extracted from discharge summaries. Statistical analysis was performed using IBM SPSS Statistics software version 25. Chi-square tests were employed for univariate analysis to assess the relationships between visual impairment, eye diseases, and MMD. Subsequently, multivariate logistic regression was utilized to calculate odds ratios (OR) and their corresponding 95% confidence intervals (CI) over a 10-year period to further investigate these relationships.

RESULTS

The incidence of visual impairment and eye diseases in MMD was 3.7%. Visual impairment and eye diseases in MMD were associated with Asian or Pacific Islander race (OR = 1.538, 95% CI 1.058-2.237), self-pay insurance (OR = 1.796, 95% CI 1.503-3.061), and hospitalization in the Midwest or North Central region (OR = 1.466, 95% CI 1.035-2.076). Visual impairment and eye diseases in moyamoya disease were associated with ischemic stroke (OR = 2.001, 95% CI 1.564-2.560), hypertension (OR = 1.508, 95% CI 1.089-2.088), headache (OR = 2.834, 95% CI 1.968-4.081), migraine (OR = 2.156, 95% CI 1.544-3.011), memory loss (OR = 3.866, 95% CI 1.493-10.012), and dizziness (OR = 1.322, 95% CI 0.549-3.182).

CONCLUSIONS

Our analysis of a large, population-based sample in the US reveals a notable association between MMD and the presence of visual impairment and eye diseases.

Relationship between visual display terminal working hours and headache/eyestrain in Korean wage workers during the COVID-19 pandemic: the sixth Korean Working Conditions Survey

Background

Prolonged use of visual display terminal (VDT) can cause eyestrain, dry eyes, blurred vision, double vision, headache and musculoskeletal symptoms (neck, shoulder, and wrist pain). VDT working hours among workers have greatly increased during the coronavirus disease 2019 (COVID-19) pandemic. Therefore, this study aimed to investigate the relationship between VDT working hours and headache/eyestrain in wage workers using data from the sixth Korean Working Conditions Survey (KWCS) (2020-2021) conducted during the COVID-19 pandemic.

Methods

We analyzed the sixth KWCS data of 28,442 wage workers aged 15 years or older. The headache/eyestrain that occurred in the last year was assessed. The VDT work group included workers who use VDT always, almost always, and three-fourth of the working hours, while the non-VDT work group included workers who use VDT half of the working hours, one-fourth of the working hours, almost never, and never. To analyze the relationship between VDT working hours and headache/eyestrain, the odds ratios (ORs) and 95% confidence interval (CI) were calculated using logistic regression analysis.

Results

Among the non-VDT work group, 14.4% workers experienced headache/eyestrain, whereas 27.5% workers of the VDT work group experienced these symptoms. For headache/eyestrain, the VDT work group showed adjusted OR of 1.94 (95% CI: 1.80-2.09), compared with the non-VDT work group, and the group that always used VDT showed adjusted OR of 2.54 (95% CI: 2.26-2.86), compared with the group that never used VDT.

Conclusions

This study suggests that during the COVID-19 pandemic, as VDT working hours increased, the risk of headache/eyestrain increased for Korean wage workers.

The Pediatric Trochlear Migraine: Diagnostic and Therapeutic Implications

Trochlear Migraine has been recently described as the concurrence of strictly unilateral migraine and ipsilateral trochleodynia with relief of migraine after successful treatment of trochleodynia. This disorder has been interpreted as "cluster-tic syndrome" or "seizure-triggered migraine". Trochlear Migraine is unrecognized and rarely described in childhood. The aim of this study is to review the few cases of Trochlear Migraine reported in the literature in addition to the cases observed in our clinical experience. In particular, our cases showed recurrent attacks of severe and pulsating headache associated with nausea, vomiting, phonophobia, photophobia, and strict trochlear localization of pain. They often presented with alternating side attacks. Therefore, we suggest that the term "Trochlear Migraine" should be reserved for clinical migraine attacks strictly localized in the trochlear region, and we assume that the excessive increase in descriptions of new primary headache syndromes, according to the International Classification of Headache Disorders, can be probably be ascribed to the common physiopathological mechanisms characterizing these forms of migraine.

Relationship of the Lateral Rectus Muscle, the Supraorbital Nerve, and Binocular Coordination with Episodic Tension-Type Headaches Frequently Associated with Visual Effort

Objective

To study the relationship between tension-type headaches and the oculomotor system in terms of binocular coordination, mechanosensitivity of the supraorbital nerve, and myofascial trigger points in the lateral rectus muscle, assessing the influence of visual effort caused by using a computer at work.

Design

Observational study with blind evaluation of the response variable.

Methods

Two groups were compared: 19 subjects with tension-type headaches and 16 healthy subjects, both exposed to computer use at work. A blinded assessor conducted three tests: measurement of the supraorbital nerve pressure pain threshold using a pressure algometer, evaluation of myofascial trigger points of the lateral rectus using the verbal numerical scale, and assessment of binocular coordination in smooth pursuit eye movements using an innovative video-oculography system. Tests were performed before work began and four hours later, and subjects in the headache group were examined when they presented a headache score of less than or equal to 3 on the verbal numerical scale.

Results

The headache group presented a greater sensitivity of the supraorbital nerve and greater local and referred pain of the lateral rectus ( P  < 0.05). Visual effort caused a significant worsening of these variables in both groups. However, binocular coordination after visual effort was only significantly affected in the headache group ( P  < 0.05), primarily in horizontal movements.

Conclusions

The finding of a higher alteration of the sensitivity of the supraorbital nerve, the myofascial trigger points of the lateral rectus, binocular coordination, and the significant influence of visual effort in patients with tension-type headaches suggest a new clinical perspective for problems related to tension-type headaches.

Headache and refractive errors in children

PURPOSE

To investigate the association between uncorrected or miscorrected refractive errors in children and headache, and to determine whether correction of refractive errors contributes to headache resolution.

METHODS

Results of ophthalmic examination, including refractive error, were recorded at initial visit for headache. If resolution of headache on subsequent visits was not documented, a telephone call was placed to their caregivers to inquire whether headache had resolved.

RESULTS

Of the 158 patients, 75.3% had normal or unchanged eye examinations, including refractions.Follow-up data were available for 110 patients. Among those, 32 received new or changed spectacle correction and 78 did not require a change in refraction.Headaches improved in 76.4% of all patients, whether with (71.9%) or without (78.2%) a change in refractive correction. The difference between these two groups was not statistically significant (P = .38).

CONCLUSIONS

Headaches in children usually do not appear to be caused by ophthalmic disease, including refractive error. The prognosis for improvement is favorable, regardless of whether refractive correction is required.

Primary headache disorders and neuro-ophthalmologic manifestations

Headache is an extraordinarily common complaint presenting to medical practitioners in all arenas and specialties, particularly primary care physicians, neurologists, and ophthalmologists. A wide variety of headache disorders may manifest with a myriad of neuro-ophthalmologic symptoms, including orbital pain, disturbances of vision, aura, photophobia, lacrimation, conjunctival injection, ptosis, and other manifestations. The differential diagnosis in these patients is broad and includes both secondary, or symptomatic, and primary headache disorders. Awareness of the headache patterns and associated symptoms of these various disorders is essential to achieve the correct diagnosis. This paper reviews the primary headache disorders that prominently feature neuro-ophthalmologic manifestations, including migraine, the trigeminal autonomic cephalalgias, and hemicrania continua. Migraine variants with prominent neuro-ophthalmologic symptoms including aura without headache, basilar-type migraine, retinal migraine, and ophthalmoplegic migraine are also reviewed. This paper focuses particularly on the symptomatology of these primary headache disorders, but also discusses their epidemiology, clinical features, and treatment.

Avaliação da sensibilidade ao contraste em pacientes com migrânea

O objetivo foi medir a Função de Sensibilidade ao Contraste (FSC) de pacientes com migrânea e de voluntários saudáveis sem a patologia. Participaram dos testes 12 voluntários do sexo feminino, seis com migrânea e seis sem migrânea na faixa etária de 20 a 37 anos. As medidas de FSC foram realizadas utilizando estímulos visuais estáticos de grades senoidais angulares com frequências espaciais de 2, 3, 4, 24 e 64 ciclos/360º Foi utilizado o método psicofísico da escolha forçada entre duas alternativas temporais, condições de luminância fotópica (luminância média da tela de 41 cd/m²) e visão binocular com pupila natural. Os resultados demonstram que a percepção visual de contraste dos voluntários com migrânea foi menor nas frequências de 2, 3, 4 e 64 ciclos/360º. Esses achados preliminares sugerem alterações na FSC relacionadas a essa patologia.

Time delay from onset to diagnosis of migraine

OBJECTIVE

To investigate the factors involved in the delayed diagnosis of migraine without aura among patients attending a tertiary center for headache diagnosis and management.

METHODS

Two hundred consecutive patients were divided into 3 groups according to the time elapsed from the first clinical manifestations and the diagnosis of migraine at our center.

RESULTS

The interval was <1 year in 16.5% of patients (n = 33); from 1 to 5 years in 30% (n = 60); and >5 years in 53.5% (n = 107). Younger age at migraine onset and a lower level of education were significantly associated with a longer time to diagnosis (P = .01 and P = .0001, respectively). Longer delays were significantly associated with a larger number of specialists consulted (P < .05).

CONCLUSION

Our findings suggest an insufficient awareness of the diagnostic criteria of migraine by non-specialist physicians, who often prescribe expensive and unnecessary diagnostic investigations that do not alleviate patients' symptoms while wasting health care resources.