Abstract
Amaç: Bu çalışmanın amacı, migren hastalarında otonomik sinir sistemi işlev bozukluğunu, invaziv olmayan ve objektif bir değerlendirme yöntemi olan otomatik pupillometri kullanarak detaylı bir şekilde incelemektir.
Gereçl ve Yöntem: Bu çalışma, 18-59 yaş aralığında toplam 128 katılımcı (64 migren hastası ve 64 sağlıklı kontrol bireyi) ile yürütülen, prospektif ve rastgele olmayan bir klinik araştırma olarak tasarlanmıştır. Tüm katılımcılar, kapsamlı bir oftalmolojik muayeneden geçirilmiş ve ardından otomatik pupillometri testine tabi tutulmuştur. Pupillometri ölçümleri; skotopik (karanlık), mezopik (loş ışık) ve fotopik (aydınlık) koşullar altında gerçekleştirilmiş, bunu takiben göz bebeği dilatasyonunun dinamik ölçümleri kaydedilmiştir.
Bulgular: Migren hastalarında ortalama göz bebeği dilatasyon hızının (0,11 ± 0,45 mm/sn) sağlıklı kontrol grubuna (0,13 ± 0,46 mm/sn) kıyasla istatistiksel olarak anlamlı düzeyde daha yavaş olduğu saptanmıştır. Ek olarak, mezopik koşullardaki göz bebeği çapı açısından iki grup arasında belirgin bir fark gözlenmiştir. Dinamik göz bebeği dilatasyonu incelendiğinde, ölçümün 10. saniyesinde Grup I (migren hastaları; 5,63 ± 0,87 mm) ve Grup II (sağlıklı kontroller; 6,05 ± 0,95 mm) arasında anlamlı bir fark olduğu belirlenmiştir..
Sonuç: Bu çalışma, migren hastalarının sağlıklı bireylere göre daha yavaş bir göz bebeği dilatasyon hızına sahip olduğunu ortaya koymuş olup, bu durum otonomik sinir sistemi işlev bozukluğuna işaret etmektedir. Bu bulgular ışığında, otomatik pupillometrinin migren hastalarında otonomik fonksiyonların değerlendirilmesi amacıyla kullanılabilecek değerli, non-invaziv ve objektif bir araç olabileceği düşünülmektedir
References
- Gazerani P, Cairns BE. Dysautonomia in the pathogenesis of migraine. Expert Rev Neurother. 2018;18:153-65.
- Sun C, Xiong Z, Sun C, Liu T, Liu X, Zhang Q et al. Placebo response in sham-acupuncture–controlled trials for migraine: a systematic review and meta-analysis. Complement Ther Clin Pract. 2023;28:101800.
- Cascio SL, Correnti E, D’Agostino S, Capizzi M, Marino A, Meli R et al. Cranial autonomic symptoms and migraine: what relationship and what meaning? A review. J Integr Neurosci. 2022;21:166.
- Noseda R, Burstein R. Migraine pathophysiology: anatomy of the trigeminovascular pathway and associated neurological symptoms, cortical spreading depression, sensitization, and modulation of pain. Pain. 2013;154:44-53.
- Miglis MG. Migraine and autonomic dysfunction: which is the horse and which is the jockey? Curr Pain Headache Rep. 2018;22:19
- Sandroni C, Citerio G, Taccone FS. Automated pupillometry in intensive care. Intensive Care Med. 2022;48:1467-70.
- Cortez MM, Millsap L, Brennan KC, Campbell CL. Craniofacial autonomic dysfunction in migraine: implications for treatment and prognosis. J Neuroophthalmol. 2020;40:67-73.
- Cambron M, Maertens H, Paemeleire K, Crevits L. Autonomic function in migraine patients: ictal and interictal pupillometry. Headache. 2014;54:655-62.
- Blitshteyn S. Is postural orthostatic tachycardia syndrome (POTS) a central nervous system disorder? J Neurol. 2022;269:725-32.
- Arnold M. Headache Classification Committee of the International Headache Society (IHS) The International Classification of Headache Disorders, 3rd edition. Cephalalgia. 2018;38:1-211.
- Guillon M, Dumbleton K, Theodoratos P, Gobbe M, Wooley CB, Moody K. The effects of age, refractive status, and luminance on pupil size. Optom Vis Sci. 2016;93:1093-100.
- Tekin K, Sekeroglu MA, Kiziltoprak H, Doguizi S, Inanc M, Yilmazbas P. Static and dynamic pupillometry data of healthy individuals. Clin Exp Optom. 2018;101:659-65.
- Sharma S, Baskaran M, Rukmini AV, Nongpiur ME, Htoon H, Cheng CY et al. Factors influencing the pupillary light reflex in healthy individuals. Graefes Arch Clin Exp Ophthalmol. 2016;254:1353-9.
- Bicer GY, Zor KR, Kucuk E. Do static and dynamic pupillary parameters differ according to childhood, adulthood, and old age? a quantitative study in healthy volunteers. Indian J Ophthalmol. 2022;70:3575–8.
- Netto MV, Ambrósio R, Wilson SE. Pupil size in refractive surgery candidates. J Refract Surg. 2004;20:337–42.
- Cortez MM, Rea NA, Hunter LA, Digre KB, Brennan KC. Altered pupillary light response scales with disease severity in migrainous photophobia. Cephalalgia. 2017;37:801-11.
- Eren OE, Ruscheweyh R, Schankin C, Schöberl F, Straube A. The cold pressor test in interictal migraine patients - different parasympathetic pupillary response indicates dysbalance of the cranial autonomic nervous system. BMC Neurol. 2018;18:41.
- Kavuncu SK, Nalcacıoglu P, Gunes NH, Ozkoyuncu D, Kara C. A shift of the pupillary balance towards the parasymphathetic system in migraine patients with aura. Noro Psikiyatr Ars. 2022;59:268-73
Abstract
Purpose: This study aims to comprehensively investigate autonomic nervous system dysfunction in migraine patients using automated pupillometry, a non-invasive and objective assessment method.
Materials and Methods: This study was designed as a prospective, non-randomized clinical trial involving a total of 128 participants aged 18–59 years (64 migraine patients and 64 healthy controls). All participants underwent a comprehensive ophthalmological examination followed by automated pupillometry testing. Pupillometry measurements were performed under scotopic (dark), mesopic (dim light), and photopic (bright light) conditions, with subsequent recording of dynamic pupil dilation measurements.
Results: The mean pupil dilation velocity in migraine patients (0.11 ± 0.45 mm/s) was found to be significantly slower compared to the healthy control group (0.13 ± 0.46 mm/s). Additionally, a significant difference was observed between the two groups in pupil diameter under mesopic conditions. Analysis of dynamic pupil dilation revealed a significant difference at the 10th second of measurement between Group I (migraine patients; 5.63 ± 0.87 mm) and Group II (healthy controls; 6.05 ± 0.95 mm).
Conclusion: This study demonstrates that migraine patients exhibit slower pupil dilation velocity compared to healthy individuals, indicating autonomic nervous system dysfunction. These findings suggest that automated pupillometry may serve as a valuable, non-invasive, and objective tool for evaluating autonomic functions in migraine patients.
Ethical Statement
This study approved by Nigde Omer Halisdemir University Local Ethics Committee (Approval No: 2022/125). The procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional or regional) and with the Helsinki Declaration of 1975, as revised in 2000.
Supporting Institution
None.
Thanks
I would like to thank Dr. Necmettin Kurtul for the precious help during the process of language revision and editing.
References
- Gazerani P, Cairns BE. Dysautonomia in the pathogenesis of migraine. Expert Rev Neurother. 2018;18:153-65.
- Sun C, Xiong Z, Sun C, Liu T, Liu X, Zhang Q et al. Placebo response in sham-acupuncture–controlled trials for migraine: a systematic review and meta-analysis. Complement Ther Clin Pract. 2023;28:101800.
- Cascio SL, Correnti E, D’Agostino S, Capizzi M, Marino A, Meli R et al. Cranial autonomic symptoms and migraine: what relationship and what meaning? A review. J Integr Neurosci. 2022;21:166.
- Noseda R, Burstein R. Migraine pathophysiology: anatomy of the trigeminovascular pathway and associated neurological symptoms, cortical spreading depression, sensitization, and modulation of pain. Pain. 2013;154:44-53.
- Miglis MG. Migraine and autonomic dysfunction: which is the horse and which is the jockey? Curr Pain Headache Rep. 2018;22:19
- Sandroni C, Citerio G, Taccone FS. Automated pupillometry in intensive care. Intensive Care Med. 2022;48:1467-70.
- Cortez MM, Millsap L, Brennan KC, Campbell CL. Craniofacial autonomic dysfunction in migraine: implications for treatment and prognosis. J Neuroophthalmol. 2020;40:67-73.
- Cambron M, Maertens H, Paemeleire K, Crevits L. Autonomic function in migraine patients: ictal and interictal pupillometry. Headache. 2014;54:655-62.
- Blitshteyn S. Is postural orthostatic tachycardia syndrome (POTS) a central nervous system disorder? J Neurol. 2022;269:725-32.
- Arnold M. Headache Classification Committee of the International Headache Society (IHS) The International Classification of Headache Disorders, 3rd edition. Cephalalgia. 2018;38:1-211.
- Guillon M, Dumbleton K, Theodoratos P, Gobbe M, Wooley CB, Moody K. The effects of age, refractive status, and luminance on pupil size. Optom Vis Sci. 2016;93:1093-100.
- Tekin K, Sekeroglu MA, Kiziltoprak H, Doguizi S, Inanc M, Yilmazbas P. Static and dynamic pupillometry data of healthy individuals. Clin Exp Optom. 2018;101:659-65.
- Sharma S, Baskaran M, Rukmini AV, Nongpiur ME, Htoon H, Cheng CY et al. Factors influencing the pupillary light reflex in healthy individuals. Graefes Arch Clin Exp Ophthalmol. 2016;254:1353-9.
- Bicer GY, Zor KR, Kucuk E. Do static and dynamic pupillary parameters differ according to childhood, adulthood, and old age? a quantitative study in healthy volunteers. Indian J Ophthalmol. 2022;70:3575–8.
- Netto MV, Ambrósio R, Wilson SE. Pupil size in refractive surgery candidates. J Refract Surg. 2004;20:337–42.
- Cortez MM, Rea NA, Hunter LA, Digre KB, Brennan KC. Altered pupillary light response scales with disease severity in migrainous photophobia. Cephalalgia. 2017;37:801-11.
- Eren OE, Ruscheweyh R, Schankin C, Schöberl F, Straube A. The cold pressor test in interictal migraine patients - different parasympathetic pupillary response indicates dysbalance of the cranial autonomic nervous system. BMC Neurol. 2018;18:41.
- Kavuncu SK, Nalcacıoglu P, Gunes NH, Ozkoyuncu D, Kara C. A shift of the pupillary balance towards the parasymphathetic system in migraine patients with aura. Noro Psikiyatr Ars. 2022;59:268-73
Details
| Primary Language | English |
|---|---|
| Subjects | Ophthalmology, Neurology and Neuromuscular Diseases |
| Journal Section | Research |
| Authors | |
| Publication Date | June 30, 2025 |
| Submission Date | March 15, 2025 |
| Acceptance Date | May 12, 2025 |
| Published in Issue | Year 2025 Volume: 50 Issue: 2 |
