Treating DED can reduce migraine severity, according to study

The prospective, randomized, double-masked, crossover trial involved 24 participants. Image credit: AdobeStock/sebra

A recent study published in Optometry and Vision Science found that in cases where migraine and dry eye disease (DED) coexist, the successful treatment of DED can reduce the severity of migraine. The prospective, randomized, double-masked, crossover trial on which the study was based was conducted from August 2022 to November 2023, with a total of 24 participants enrolled and completing all visits.¹

“Treating [DED] with ocular lubrication is associated with a significant reduction in migraine disability as measured by the [Headache Impact Test 6, or] HIT-6,” the study authors stated. “Applying this outcome to clinical practice suggests that, where [DED] and migraine coexist, the severity of both conditions may be reduced by the use of readily available ocular lubricants as a possible treatment option in some patients.”

Study authors also cited physiological similarities between migraine and DED “that are both believed to be linked to the pathological activation of the trigeminovascular system.” Researchers developed their hypothesis of treating DED in reducing migraine severity in the similarity of these pathophysiological mechanisms.¹

Inclusion criteria for the study were individuals 18 years and older with either episodic migraine or chronic migraine, as based on the International Classification of Headache Disorder 3 criteria, with DED. Individuals with an Ocular Surface Disease Index (OSDI) score of >12 or Dry Eye Questionnaire 5 (DEQ-5) score of ≥6, with at least 1 of the following ocular signs:

• Tear breakup time <10 seconds
• The presence of ocular surface damage (corneal or conjunctival staining ≥grade 1 on the Oxford scale)
• Tear osmolarity ≥308 mOsm/L in either eye
• A difference of >8 mOsm/L between eyes

Exclusion criteria included those with malignant disease, diabetes, multiple sclerosis, connective tissue disease, infectious disease, and a history of other medical illnesses known to be associated with neuropathy or treatment with neuromodulatory medication or cytotoxic agents, among others.¹

In the study, no changes to any treatment courses or routines for eye and noneye conditions were permitted. Participants were allowed to take regular acute migraine medications but could not change their preventive migraine treatment. Participants received either Systane Hydration UD (Alcon, Fort Worth, TX) or saline eye drops (NeilMed, Santa Rosa, CA) 4 times a day for 4 weeks each. Participants also received a 2-week washout period between treatments. After each follow-up visit, participants were assessed for any changes in eligibility criteria, the number of days using the eye drops as self-reported, treatment-emergent adverse events, and outcome measures.¹

Migraine severity was also assessed with Migraine Disability Assessment questionnaires. DED was evaluated using the OSDI, the DEQ-5, tear breakup time, tear osmolarity, and corneal surface integrity. Outcomes were assessed at baseline and after using the first and then the second drops. Saline was chosen as an active comparator due to its wide availability and isotonic composition.¹

Results from the HIT-6 score found a reduction from baseline when using Systane Hydration UD (mean change, ∆ = −3.0, P=.01) and saline (∆ = −3.9, P=.002). DED symptoms and corneal staining were also reduced when using Systane Hydration UD (OSDI ∆ = −8.3, P=.004; DEQ-5 ∆ = −2.1, P=.004; corneal staining ∆ = −2.2, P=.001) and saline (OSDI ∆ = −6.4, P=.03; DEQ-5 ∆ = −1.5, P=.03; corneal staining ∆ = −1.5, P=.005).¹

A reduction in the MIDAS score was also found, suggesting a possible improvement in disability after using the ocular lubricants, but these changes did not reach statistical significance (P>.08).¹

Reference:

1. Isa NAM, Krishnan, AV, Zagami, AS, et al. A randomized crossover trial: The impact of ocular lubrication on migraine severity in persons with dry eye disease and migraine. Optom and Vis Sci. 2025;102(4):183-188. doi:10.1097/OPX.0000000000002241