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Association Between Dry Eye Disease and Migraine Headaches in a Large Population-Based Study

Educational Objective
To determine the strength of the association between dry eye disease and migraine headaches.
1 Credit CME
Key Points

Question  What is the association between dry eye disease and migraine headaches?

Findings  In this population-based case-control study of 72 969 patients, the odds of having dry eye disease with a diagnosis of migraine headaches was at least 20% higher than that of individuals without a diagnosis of migraine headaches.

Meaning  Although this association may not reflect cause and effect if unidentified confounders account for the findings, these results suggest that patients with migraine headaches may be at risk of carrying a comorbid diagnosis of dry eye disease.

Abstract

Importance  Reports in the literature have conflicting findings about an association between dry eye disease (DED) and migraine headaches.

Objective  To determine the strength of the association between DED and migraine headaches.

Design, Setting, and Participants  This retrospective case-control study included 72 969 patients older than 18 years from University of North Carolina–affiliated health care facilities from May 1, 2008, through May 31, 2018. Deidentified aggregate patient data were queried; data were analyzed from June 1 through June 30, 2018.

Exposures  Diagnosis of migraine headache.

Main Outcomes and Measures  Odds ratios calculated between DED and migraine headaches for participants as a whole and stratified by sex and age group.

Results  The base population consisted of 72 969 patients, including 41 764 men (57.2%) and 31 205 women (42.8%). Of these, 5352 patients (7.3%) carried a diagnosis of migraine headache, and 9638 (13.2%) carried a diagnosis of DED. The odds of having DED given a diagnosis of migraine headaches was 1.72 (95% CI, 1.60-1.85) times higher than that of patients without migraine headaches. After accounting for multiple confounding factors, the odds of having DED given a diagnosis of migraine headaches was 1.42 (95% CI, 1.20-1.68) times higher than that of patients without migraine headaches.

Conclusions and Relevance  These findings suggest that patients with migraine headaches are more likely to have comorbid DED compared with the general population. Although this association may not reflect cause and effect if unidentified confounders account for the results, these data suggest that patients with migraine headaches may be at risk of carrying a comorbid diagnosis of DED.

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Article Information

Accepted for Publication: December 22, 2018.

Corresponding Author: Richard M. Davis, MD, Department of Ophthalmology, University of North Carolina, Chapel Hill, 2226 Nelson Hwy, Ste 200, Chapel Hill, NC 27517 (richard_davis@med.unc.edu).

Published Online: March 7, 2019. doi:10.1001/jamaophthalmol.2019.0170

Author Contributions: Mr Ismail had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Ismail, Poole, Meyer, Davis.

Acquisition, analysis, or interpretation of data: Ismail, Poole, Bierly, Van Buren, Lin, Meyer.

Drafting of the manuscript: Ismail, Poole, Meyer.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: Ismail, Poole, Van Buren, Lin.

Administrative, technical, or material support: Bierly, Davis.

Supervision: Lin, Meyer.

Conflict of Interest Disclosures: Dr Lin reported receiving grants from the National Center for Advancing Translational Sciences, National Institutes of Health (NIH) during the conduct of the study. No other disclosures were reported.

Disclaimer: This content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

Additional Contributions: i2b2 software was used in conducting this study. i2b2 is the flagship tool developed by the i2b2 (Informatics for Integrating Biology and the Bedside) Center, an NIH-funded National Center for Biomedical Computing based at Partners HealthCare System. The i2b2 instance at the University of North Carolina is supported by grant UL1TR002489 from the National Center for Advancing Translational Sciences, NIH.

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