FAQ Episode 27: Dry eyes and Migraine, what's the connection?
FAQs for Natural Migraine Relief for Women
Ask a dozen people with migraines about their trigger factors and you will hear a dozen (or more) ‘recipes for a headache.’ Because it usually develops gradually, one underappreciated yet provocative factor for migraine is a reduction in effective eye lubrication. In the U.S., at least five percent of adults have a significant dry eye problem. If you are in this group - or think you might be - and also have migraines, this article is for you.
In this review, we will discuss:
-what processes contribute to dry eyes
-how dry eyes promote migraines
-how to manage the dry eyes/migraine connection.
What processes contribute to dry eyes
Your eyes are lubricated by a combination of watery and oily tear elements, which leads to several versions of dry eyes:
aqueous deficient dry eye: This is when your eyes don’t produce enough tears. Your lacrimal glands live in the upper, outer corner of each eye and produce your aqueous tears. These tears make up the middle, more watery layer of your tear film. Autoimmune conditions like Sjogren’s sundromecause inflammation in the lacrimal gland and then reduces the aqueous tears it produces. The process of reduced tear production is also inevitable with aging, sometimes noted as early as one’s 40s.
evaporative dry eye: This is when your tears evaporate too quickly. The most common cause is meibomian gland dysfunction. This means the glands in your eyelids that produce the outer, oily layer of your tear film don’t work properly. As a result, the oily layer is unstable and lets the watery layer dry up too easily.
mixed dry eye: When you have both aqueous tear deficiency and oil gland dysfunction. This results in both less tears and tear film instability, an even worse contributor to dry eyes.
Factors that contribute to or complicate a dry eye situation:
those with diabetes have a 50/50 chance of developing dry eyes as a complication.
thyroid eye disease (Grave’s disease/hyperthyroidism)
deficencies in hormones. The peri-menopausal to post-menopausal time frame can at times encompass a decade, where hormonal support for skin and glands drop dramatically. Reduced estrogen, progesterone and testosterone all play potential roles in dry eyes.
about 10% of those who have the aqueous deficient version of dry eyes have Sjögren’s syndrome, an autoimmune disorder.
deficincies in nutrients. Deficits in Vitamins D and A have been associated with dry eye. Omega fatty acids can be helpful for optimal Mebomian gland function
chronic blepharitis, which is an inflammation or infection of blocked oil glands.
tear osmolarity, or the amount of salt in your tears. It turns out that the saltier the tears, the more likely the odds of associated migraine, especially with an aura. Being chronically dehydrated can worsen this.
several drugs may promote dry eye, including:
-isotretinoin for acne (Retin-A)
-antidepressants, such as SSRIs (Prozac, Paxil, etc.)
-metformin, prescribed for diabetes and weight loss
-enalapril, used for hypertension
increased screen time and reduced blink rate which allow the cornea to dry out more easily.
wearing contact lenses, which can reduce oxygen to the cornea and also wick off some of your natural tears.
exposure to environmental irritants such as wind, low humidity, air-conditioning, sun, smoke, chemical fumes, or heat
seasonal allergies
How dry eyes promote migraines
excessive dryness of the ocular surface can trigger reflex tearing via the trigeminal nerve, which is the largest cranial nerve and is responsible for providing sensory input to the face. This can lead to subsequent auras and acute migraine attacks, given the prominent role of the trigeminal ganglion in the pathophysiology of migraine headaches.
dry eyes lead to an unstable tear film, which may affect light refraction and this can lower the threshold for a headache.
dry eyes and migraine can share the problem of photophobia, where an overload of the light-receptive neurons in your brain can promote inflammation in the central nervous system. Photophobia can promote migraines, as well as, lower the threshold for pain tolerence, leaving you with a greater pain burden per migraine event.
Managing the dry eyes/migraine connection
Here’s thirteen options for minimizing both dry eyes and their potential impact on migraines:
use over-the-counter remedies like artificial tears 2-3 times a day. You can use saline, or brands like Liquid Tears, Thera-Tears, Refresh, GenTeel or Systane.
reduce your screen time, and/or optimize hydration with eye drop hydration at the times when you have to do screen work.
you may need an in-office test to evaluate for adequate tear production (the Schirmer test.)
you and your doctor may need to discuss the use of prescriptions such as cyclosporine (Restasis,) perfluorohexyloctane (Miebo,) and lifitegrast (Xiidra) eye drops to help resuscitate tear production capacity.
you may benefit from a daily supplement that supports omega-3s and Vitamins D and A. If you take Vitamin D, consider getting a blood level taken to optimize dosing (see FAQ Episode 11). For Vitamin A, useful doses can go up to 10,000 IU daily short term, or 5000 IU ongoing. Pregnant or pregnency expectant women should not take more than 5000 IU/day.
if you are approaching, well into, or past menopause, you will have hormone deficiencies that promote dry eyes. Individualized hormone support can be very helpful for all epithelial tissues, including the eyes.
in some cases surgery to place tear duct plugs or to repair eyelid droop or deformity may be helpful.
wear tinted lenses in sunlight, or wraparound glasses when windy.
wear your glasses instead of contact lenses whenever possible. Keep total hours of contact wear to a minimum and strictly avoid wearing contact lenses when sleeping, even for a nap.
use a humidifier in your home, especially in the low humidity wintertime.
apply warm compresses for dry eyes and cool compresses for migraines over closed eyes.
stay hydrated by drinking eight to ten glasses of water each day
get at least seven hours of quality sleep each night. It can also be helpful to apply an eye gel like non-Rx GenTeel or Optifresh, placing a small stripe of the gel in the lower eyelid just before putting head to pillow.
Managing dry eyes is only one of almost a hundred non-drug therapy options I’ve found useful for migraine headaches. If you would like to understand the broader range of root cause factors that drive your migraines and then individualize more intelligently from among the many possible therapy options, take a look at my comprehensive Natural Migraine Relief for Women course and its unique Migraine Action Plan system. See www.naturalmigrainerelief.online for more details.
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