Retinal Vasculature Changes in Migraine With Aura: Katherine Podraza, MD, PhD

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"In the future, I think we’ll have more evidence suggesting that this is a marker of vasculopathy and could be used early on to evaluate which patients are at risk. I think it's early on in the research but I believe it's a great avenue to continue studying migraine, looking at the effect on vasculature in the retina for migraine patients moving forward.”

In prior research, migraine has been associated with several ophthalmic diseases, such as central retinal artery and vein occlusions. In one small scale study of 21 patients, results showed that 24% had retinal arterial occlusions and a history of migraine.¹ Thus, the findings suggest that migraine may be a risk factor for ischemic events of the retina and optic nerve. A tool that could be used to provide details on the retinal microvasculature structure is the optical coherence tomography angiography (OCTA) since it is an advanced and fast imaging technology for noninvasive visualization of vascular systems.

According to a recent study, findings showed a reduction in foveal perfusion interictally in patients with migraine with aura (MA) in comparison with those with migraine without aura (MO). Additionally, data showed a reduction in parafoveal perfusion in both the migraine groups during a migraine attack using an OCTA-based retinal perfusion measure.² These results were presented at the 2022 American Headache Society (AHS) Annual Meeting, June 15-18, in Austin, Texas, by lead author Katherine Podraza, MD, PhD, in the Early Career Award Lecture.

Podraza, a headache specialist at Hartford Healthcare Headache Center, recently sat down with NeurologyLive® at the meeting to discuss how the altered retinal vasculature observed in patients with MA could be an inherent characteristic or a result of repeated attacks over time. She also talked about how the discovery of retinal vasculature changes might impact the management and treatment strategies for individuals with MA. Additionally, she explained how the OCTA could become an essential tool to use for early detection and risk assessment in patients with MA.

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REFERENCES
1. Ke W, Yu N, Liu X, et al. Analysis of macular microvasculature with optical coherence tomography angiography for migraine: A systematic review and meta-analysis. Front Neurol. 2022;13:1001304. Published 2022 Oct 13. doi:10.3389/fneur.2022.1001304
2. Podraza K, Bangera N, Feliz A, Charles A. Analysis of retinal microvasculature during a migraine attack using an Optical Coherence Tomography Angiography based retinal perfusion measure. Presented at: AHS Annual Meeting, 2023; June 15-18; Austin, TX. EC-1.