Vascular Changes in the Macula and Peripapillary Regions Using Optical Coherence Tomography Angiography in Migraine with Aura and Migraine Without Aura

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Background: The aim of this study was to assess the macular vasculature and retinal thickness using optical coherence tomography angiography (OCTA) in patients with migraine with aura (MA) and migraine without aura (MO) compared with healthy controls (HCs). Methods: A prospective cohort study included 37 MO patients, 34 MA patients, and 34 HCs. Vessel density (VD) in the superficial and deep retinal plexuses, radial peripapillary capillaries (RPC), optic nerve head (ONH), and foveal avascular zone (FAZ) was measured. The retinal thickness, retinal nerve fiber layer (RNFL) thickness, visual field parameters, and body mass index (BMI) were also evaluated. Results: Significantly lower macular superficial VD in the whole image was observed in the MA group compared with both the MO and HCs. MO patients showed higher RPC VD in the inferior quadrant compared with HCs. No significant differences were found in the RNFL thickness, deep plexus, FAZ area, non-flow area, or visual field parameters. In the MA group, the FAZ area showed a significant inverse correlation with the BMI, and a higher incidence of comorbidities was observed, particularly of Hashimoto’s thyroiditis. Conclusions: These findings suggest that migraine subtypes are associated with distinct retinal microvascular patterns detectable via OCTA. Reduced macular perfusion in MA and increased peripapillary perfusion in MO may reflect subtype-specific vascular dysregulation. OCTA may therefore serve as a noninvasive biomarker for detecting early microvascular alterations in migraine.

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