Dry Eye Symptoms Associated With Reduced Visual Quality of Life in Migraine

Woman holds hand up to pain behind eye
Woman holds hand up to pain behind eye
Researchers aimed to identify the ocular symptoms driving the reduction in visual quality of life in patients with migraine.

Dry eye symptoms are associated with a significant reduction in visual quality of life in patients with migraine, according to study results published in Headache.

Results from previous clinical studies have shown that photophobia, aura, dry eye, or a combination of these symptoms are most likely to contribute to a reduction in visual quality of life in patients with migraine. The quality of life instruments used in these studies measured several different dimensions; therefore, researchers have been unable to determine which ocular symptoms contribute to reduced visual quality of life. The objective of this study was to identify the ocular symptoms driving the reduction in visual quality of life in patients with migraine.

In this cross-sectional, survey-based study, researchers recruited patients with migraine from the Headache and General Neurology clinics at the University of Utah Health Sciences Center. Patients completed 5 validated questionnaires: The National Eye Institute visual function questionnaire (VFQ-25), the headache impact test (HIT-6), the visual aura rating scale (VARS), the ocular surface disease index (OSDI), and the Utah photophobia symptom impact scale (UPSIS-17). 

Patients were characterized as having migraine with aura, migraine without aura, episodic migraine, and/or chronic migraine. Associations between VFQ-25 and OSDI, VFQ-25 and VARS, VFQ-25 and UPSIS-17, HIT-6 and OSDI, HIT-6 and VARS, and HIT-6 and UPSIS-17 were calculated using Pearson’s correlation coefficients with P values, and a simple linear regression model was used to examine the relationship between VFQ-25, OSDI, VARS, and USPIS-17.

Results revealed that of the patients who completed all questionnaires (n=62), 17 had episodic migraine, 45 had chronic migraine, 23 had migraine with aura, and 39 had migraine without aura. The strongest correlation observed was between VFQ-25 and OSDI (−0.678; P <.001); this correlation remained with the inclusion of patient subpopulations. Significant correlations were observed between HIT-6 and OSDI (0.453; P <.001), and between HIT-6 and UPSIS-17 (0.489; P <.001). Simple linear regression model only found a significant relationship between VFQ-25 and OSDI.

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Factors which may have limited these findings include similarities between the OSDI and VFQ-25 questionnaire and the small number of individuals in the migraine group. Moreover, the focus on patients in a tertiary hospital may limit the ability to generalize these results to other clinical settings.

Researchers concluded that “although photophobia and aura negatively affect visual quality of life, dry eye symptoms appear to be the strongest driver of poor visual quality of life.” They add that the correlation between photophobia and headache “lends support to our previous finding that treating photophobia can positively influence headache impact.”

Disclosure: Multiple authors declared possible conflicts of interest. Please see the original reference for a full list of authors’ disclosures.


Ozudogru S, Neufeld A, Katz BJ, et al. Reduced visual quality of life associated with migraine is most closely correlated with symptoms of dry eye [published online September 26, 2019]. Headache. doi:10.1111/head.13662

This article originally appeared on Neurology Advisor