ORIGINAL ARTICLE Topographical Analysis of the Optic Nerve in Migraine Patients TERRY D. MOEHNKE, OD, MS, FAAO, JOSEPH SOWKA, OD, FAAO, JOSEPHINE SHALLO-HOFFMANN, PhD, FAAO, PATRICK HARDIGAN, PhD, and ALBERT D. WOODS, MS, OD, FAAO College of Optometry (TDM, JS, JS-H, ADW), and Office of Assessment, Evaluation and Faculty Development (PH), Nova Southeastern University, Fort Lauderdale, Florida ABSTRACT Purpose. Vascular dysfunction appears related to the development of migraines and has been associated with pressure- independent glaucoma. The purpose of this study is to investigate possible topographical differences in the optic nerve between migraine sufferers and normal age-matched control subjects. The identification of optic disc topographical differences between migraine and non-migraine sufferers may help clinicians determine if the presence of migraine influences the development and progression of glaucoma. Methods. Sixty consecutively seen patient-volunteers (30 subjects in migraine group: mean age 37.7 years, range from 19 to 66 years, 28 females and 2 males; 30 subjects in the control group: mean age 37.6 years, range from 19 to 61 years, 29 females and 1 male) were categorized as either migraine patients or control group subjects. All migraine subjects had been medically diagnosed with a migraine syndrome and were being treated with prophylactic medication. Optic nerve head topographical analysis was performed using a confocal scanning laser ophthalmoscope. The data was evaluated using generalized estimating equations, a priori and post hoc power analysis. Results. No significant differences were found in any of the optic nerve parameters examined between the two groups. Conclusions. This study indicates that the optic nerve parameters as measured by the Heidelberg retinal tomograph II do not differ between migraine sufferers and age-matched control subjects. (Optom Vis Sci 2008;85:566–573) Key Words: migraine, glaucoma, topography, optic nerve, generalized estimating equations A n estimated 29 million people in the United States suffer from migraine headaches, with women almost three times as likely to suffer from the headaches as men. 1 Migraine headache occurs in 3 to 10% of all children and up to 25% of adolescents with the peak prevalence occurring between the ages of 35 to 45 years. 2 Migraine is a chronic, recurrent neurological con- dition resulting in periodic attacks of head pain which may cause a one-sided pulsating moderate or severe headache. These headaches may last for several hours accompanied by gastrointestinal upsets and heightened sensitivity to bright lights and noise. In some cases migraines can convert from occasional episodic attacks to a chronic condition 3 which in turn can lead to subclinical brain lesions. 4,5 Faced with only subjective complaints that may be misleading and no standardized diagnostic tests, physicians must rely on the patients’ description of the pain and associated symptoms to de- termine if migraine is present. The Headache Classification Com- mittee of the International Headache Society developed a stan- dardized system that utilizes clinical presentation and laboratory tests to include or exclude features that are needed to establish a particular diagnosis. 6 The diagnosis of migraine under the Inter- national Headache Society criteria is based on the patient’s report of previous headache attacks and specific descriptive steps that assess disability, nausea, and photophobia. 7,8 The etiology of migraine is unknown but several theories have been presented in an effort to explain the pathophysiology. In the late 1930s, Graham and Wolff determined the temporal artery dilated during a migraine attack and this lead to the pain associated with the headache attack. 9 Wolff hypothesized the aura that pre- ceded the headache and the visual symptoms associated with the migraine attack were the result of vasospasm that lead to the re- duction of blood flow to the brain. The clinical concept of vaso- spasm was first described in the late 1850s by Gull who reported 1040-5488/08/8507-0566/0 VOL. 85, NO. 7, PP. 566–573 OPTOMETRY AND VISION SCIENCE Copyright © 2008 American Academy of Optometry Optometry and Vision Science, Vol. 85, No. 7, July 2008