The Link Between Dry Eye and Migraines

If you deal with both migraines and dry eyes, it might not just be a coincidence—there may actually be a connection between the two. In fact, research suggests that migraine attacks may be longer and more severe in people with dry eye syndrome compared to those without it. There also seem to be some similarities between the two in terms of underlying mechanisms that cause them to occur.

Why Dry Eye Occurs

Dry eye syndrome (a.k.a. dry eye disease) is a complex condition involving impaired tear function, as well as eye surface abnormalities. It often stems from increased water loss from the surface of your eye, increased salt content in your tears, or decreased tear production.

However, there's more and more evidence that many people have symptoms of dry eye that are unrelated to these causes, proving that dry eye syndrome is more complicated than anyone previously thought.

For example, sometimes dry eye syndrome develops as the result of an underlying medical condition, such as Sjögren's syndrome. Incidentally, people with this autoimmune condition also have a significantly higher incidence of migraine and headache than those without.

Migraineurs With Dry Eye

Most of the studies on the link between migraine and dry eye syndrome have been fairly small, but there is a relationship worth exploring.

Several of these studies have found an increased frequency of dry eye syndrome in people with migraine compared to the general population, and this association seems to be even more significant in people who have migraine with aura.

One 2017 study looking at this link measured tear osmolarity—a common test for dry eyes that shows how much salt content is in your tears—in 34 migraineurs. As with similar earlier studies, the researchers found that migraine (especially migraine with aura), had a significant association with dry eyes. They also saw that as the frequency of migraines increased, so did tear osmolarity; more salt can lead to further drying. In participants who had a shorter duration of head pain, there was also an association with higher tear osmolarity.

A 2015 study of 58 migraineurs found that those with dry eye had significantly longer migraine attacks and had been dealing with migraine for longer than those without dry eye.

Migraine attacks may be worsened when you also have dry eyes, and dry eye syndrome may contribute to continuing migraines, say researchers.

Another 2017 study of 959,881 U.S. veterans, primarily men who had been diagnosed with dry eye syndrome, sought to look at the link between chronic pain conditions, such as migraine, and dry eyes. Not surprisingly, the study found that dry eyes were more common in those with a chronic pain condition than those without.

The frequency of dry eyes also increased as the number of chronic pain conditions a participant had increased. This suggests that having dry eyes may actually be an indication that there's a chronic pain condition present, such as migraine, temporomandibular joint dysfunction (TMD), chronic fatigue syndrome, fibromyalgia, irritable bowel syndrome (IBS), or facial, neck, or back pain.

Possible Shared Mechanisms

No one knows for sure what causes dry eye syndrome and migraine, but there are a number of theories. Experts think that the two conditions may share these mechanisms:

  • Inflammation: Inflammatory processes seem to be involved in causing both dry eye syndrome and migraine.
  • Central sensitization: This condition occurs when your central nervous system becomes overreactive to certain stimuli, such as light, noise, touch, or sound, causing more intense pain and a lower pain tolerance. It's associated with a wide variety of chronic pain conditions, including migraine, and it appears to occur in dry eye syndrome as well, occurring in ways like experiencing eye pain from wind, cold, or light.
  • Genetics: There has been a genetic component identified in both conditions, meaning that they tend to run in families. Dry eye syndrome has even been linked genetically to IBS, chronic pelvic pain, and fibromyalgia.
  • Trigeminal nerve pathway: The trigeminal nerve, the largest of the 12 cranial nerves, supplies nerves to the eyes and is involved in tear production. Scientists believe that when the trigeminal nerve system is activated, it can trigger migraines and aura. Dry eye symptoms are also thought to be the result of an activated trigeminal nerve, especially since there are dense trigeminal nerve endings in the cornea.

A small 2015 study found that the participants with migraine and symptoms of dry eye syndrome had significantly less dense corneal nerve fiber than those without migraine, supporting the hypothesis that the trigeminal nerve is, indeed, involved in the association between the two.

Overlapping Symptoms

Given all of this, it might not come as a surprise that migraine and dry eye syndrome share two common symptoms.

Photophobia

Photophobia is light sensitivity and/or abnormal pain when you're exposed to light. It affects between 80 percent to 90 percent of migraineurs and the majority of people with dry eye syndrome report experiencing light sensitivity as well.

Eye Pain

If you have migraines, you likely know that the pain sometimes feels like it's in, around, or behind your eye(s). Dry eye syndrome can also cause eye pain with a gritty, irritated, and/or a burning sensation. You may often feel like there's a foreign body in your eye, and you may also notice that your eyes are red. And though it might seem strange, many people with dry eye have excessive eye tearing, a symptom some migraineurs experience too.

Symptoms of dry eye syndrome tend to come and go within different environments. For example, they tend to be worse in windy and/or cold weather. In addition, dry eye syndrome can mimic symptoms of other common eyes conditions like allergic or viral conjunctivitis, blepharitis, or a bacterial eye infection. This is why a proper eye examination is needed if you believe you have dry eye symptoms.

Other Commonalities

Dry eye syndrome and migraine, as well as the other chronic pain conditions mentioned above, have some factors in common, including:

  • Females primarily affected: Dry eye syndrome and chronic pain conditions like migraine are both far more common in women. This makes the veterans' study all that much more interesting since the high number of men in the study who had dry eye syndrome along with chronic pain conditions suggests even more strongly that these illnesses have similar mechanisms.
  • Shared comorbidities: Both conditions tend to co-occur with sleep disorders, fatigue, anxiety, depression, and other chronic pain conditions.
  • Decreased quality of life: Both conditions can have a negative impact on quality of life because they may reduce the ability to do activities of daily living like watching TV, reading, driving, or working on a computer.
  • Disconnect between signs and symptoms: Though symptoms are present in both conditions, they often don't have any obvious clinical signs that would indicate a direct physical cause, such as nerve damage or structural problems.
  • Somatosensory dysfunction: There's evidence of somatosensory dysfunction, a faulty response in the way your brain perceives neural impulses, in both migraine and dry eye syndrome. These dysfunctions include allodynia (feeling pain from something that doesn't normally cause pain, like touch), hyperalgesia (feeling more pain than normal from something that causes pain), and hypoesthesia (having less sensation or sensitivity to normal stimuli).

The Bottom Line

More research is needed to say for sure, but it's possible that treating dry eye syndrome may improve your migraines.

Treating Dry Eyes

The first-line treatment for dry eyes is artificial tears, which are available over-the-counter in liquid, gel, or ointment forms. Preservative-free artificial tears may be ideal, although sometimes these are costly.

Xiidra (lifitegrast) and Restasis (cyclosporine) are both prescription eye drops that contain medication that helps promote tear production. Your doctor may give you one of these if artificial tears aren't doing the trick.

There are also environmental coping strategies like staying away from air conditioners or heaters and placing a humidifier in your bedroom and/or place of work. Making an effort to blink frequently when you are doing work on your computer or reading can also be helpful.

If you have symptoms of dry eye syndrome, or you're not getting relief from artificial tears and environmental and lifestyle strategies, seeing an ophthalmologist (a doctor who specializes in treating the eye) is your next best step.

A Word From Verywell

Remember, a link does not mean that one condition causes the other. Rather, a link implies a connection or relationship that may or may not have any significance for you as an individual. That said, if you do suffer from irritated, dry eyes and migraines, talk to your doctor, since it's entirely possible that treating your dry eyes could help improve your migraines. As migraineurs know, it often takes a variety of different strategies and therapies to minimize migraine pain and avoid triggers, so treating dry eyes has the potential to be yet another tool in your kit.

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