A randomized crossover trial: The impact of ocular lubrication on migraine severity in persons with dry eye disease and migraine.

Significance: Significant associations in the epidemiologic and clinical features between migraine and dry eye syndrome suggest that both conditions are comorbid. A potentially overlapping pathophysiological mechanism further indicates a connection between the two conditions. This study highlights the clinical implications of treating dry eye disease on migraine.

Purpose: This study aimed to investigate the impact on migraine severity of treating dry eye disease in migraine patients using ocular lubricants.

Methods: A randomized, double-masked, crossover trial was conducted on 24 participants with both migraine and dry eye disease. They received either Systane Hydration UD (Alcon, Fort Worth, TX) or saline eye drops (NeilMed, Santa Rosa, CA) four times per day for 4 weeks each, with a 2-week washout period between treatments. Migraine severity was assessed using the Headache Impact Test 6 (HIT-6) and Migraine Disability Assessment questionnaires. Dry eye disease was evaluated using the Ocular Surface Disease Index (OSDI), Dry Eye Questionnaire 5 (DEQ-5), tear breakup time, tear osmolarity, and corneal surface integrity. Outcomes were assessed at baseline and after using the first and then second drops.

Results: Ocular lubrication was significantly associated with reduced migraine severity and dry eye disease. The HIT-6 score was reduced from baseline when using Systane Hydration UD (mean change, ∆ = -3.0, p=0.01) and saline (∆ = -3.9, p=0.002). Dry eye disease symptoms and corneal staining were reduced when using Systane Hydration UD (OSDI ∆ = -8.3, p=0.004; DEQ-5 ∆ = -2.1, p=0.004; corneal staining ∆ = -2.2, p=0.001) and saline (OSDI ∆ = -6.4, p=0.03; DEQ-5 ∆ = -1.5, p=0.03; corneal staining ∆ = -1.5, p=0.005).

Conclusions: When migraine and dry eye disease coexist, successfully treating dry eye disease reduces the severity of migraine, as measured by HIT-6.