Increased Vagal Tone in Ocular Migraine
Yes, increased vagal tone is associated with ocular migraines, as migraine headache and peripheral vasospasm have been identified as risk factors for glaucomatous optic nerve damage, with these conditions potentially decreasing autoregulation of optic disc blood flow. 1
Autonomic Nervous System Dysfunction in Migraine
- Migraine attacks involve dysregulation of the autonomic nervous system, with an imbalance occurring between sympathetic and parasympathetic (vagal) tone 2
- During migraine attacks, features indicative of altered autonomic function include nausea, vomiting, diarrhea, polyuria, eyelid edema, conjunctional injection, lacrimation, nasal congestion, and ptosis 2
- The parasympathetic system supplying the meninges causes increased vasodilation and pain during migraine attacks 3
Ocular Migraine and Vagal Involvement
- Ocular migraine is an uncommon cause of transient monocular visual loss that physicians should recognize to provide appropriate treatment 4
- The Brugada syndrome research provides insight into how increased vagal stimulation and/or withdrawal of sympathetic activity can affect vascular conditions, which may be relevant to understanding ocular migraine mechanisms 1
- Migraine headache and peripheral vasospasm decrease autoregulation of optic disc blood flow compared to patients without this history 1
Clinical Implications of Vagal Tone in Migraine
- Migraine headaches alone may actually decrease visual field sensitivity during the attack 1
- Clinicians should consider migraine and peripheral vasospasm as risk factors for progressive glaucoma 1
- The vagus nerve serves as a critical pathway that can sense the gut microenvironment and transfer this information to the brain, potentially influencing migraine pathophysiology 5
Therapeutic Considerations
- Noninvasive vagus nerve stimulation has been studied as a potential treatment for acute migraine, with some patients showing benefit 6
- Understanding the role of autonomic dysfunction in migraine can help develop more targeted treatments 2
- Cortical spreading depression (CSD) is the underlying phenomenon in migraine with and without aura, and migraine-preventive drugs increase the CSD threshold and reduce CSD velocity 7
Diagnostic Features
- Migraine with aura includes visual symptoms that last 5-60 minutes, with at least one aura symptom spreading gradually over 5 minutes 1
- Visual auras are characterized by bright scintillating lights or zigzag lines, often with a scotoma that interferes with reading 1
- The visual disturbances in ocular migraine can range from occasional small flashes of light to complex visual hallucinations, with stereotyped teichopsia being the most typical pattern 7
The evidence strongly supports that increased vagal tone plays a significant role in the pathophysiology of ocular migraine, contributing to the visual disturbances and other symptoms experienced during attacks.