Individuals with migraines have been known to have a higher risk of glaucoma development, and a new study published in Neurology suggests that use of preventative medication for migraines may be connected with reduced instance of glaucoma development.
“Glaucoma is a leading cause of blindness, and evidence has linked migraine with an increased risk of glaucoma, with both conditions affecting the capacity of the blood vessels in the brain to alter blood flow in response to stimuli,” said the study lead, Chien-Hsiang Weng, MD, clinical associate professor at Brown University.
Weng and his team surmised that drugs that help to regulate blood vessel function to prevent migraines may also help prevent the development of glaucoma. The researchers focused on assessing the efficacy of calcitonin gene-related peptide inhibitors (CGRPi), which included six medications: erenumab, fremanezumab, galcanezumab, eptinezumab, atogepant, and rimegepant.
“Since CGRP inhibitors help regulate blood vessel contraction and inflammation in the nervous system, there has been hope that these drugs could benefit eye health in people at risk of glaucoma,” said Weng.
In this retrospective cohort study, the researchers collected data from a healthcare database including individuals who were prescribed migraine prevention drugs with at least one refill between 2018 and 2024. These individuals were tracked for three years to identify glaucoma diagnoses.
The researchers analyzed data from over 73 thousand participants, 36,822 of which were prescribed drugs from the CGRPi group to prevent migraine, and an equivalent number of people prescribed non-CGRPi drugs (including valproate, topiramate, flunarizine, candesartan, lisinopril, metoprolol, propranolol, nadolol, amitriptyline and venlafaxine). To prevent confounding the data, the researchers point out that “Crossovers were not allowed, and the non-CGRPi group included only individuals who never used CGRPi.”
Primary analysis using the Cox proportional hazards model showed that within the first three years from the first prescription of the migraine medication, 153 people (0.42%) in the CGRPi group developed glaucoma, compared to 223 people (0.61%) of those in the non-CGRPi group.
When adjusted for glaucoma risk factors including migraine frequency, history of high blood pressure, and age, individuals taking CGRPi drugs have a 25% lower risk of developing glaucoma compared with those taking the non-CGRPi drugs.
Not all CGRPi drugs showed equal effectiveness in reducing the risk of developing glaucoma. The authors specify that “only users of monoclonal antibody CGRPi show a reduced risk of glaucoma compared with non-CGRPi users (HR 0.77; 95% CI 0.61–0.98).”
Additionally, not all participants responded to the CGRPi medications equally. “The reduced risk of glaucoma associated with CGRPi is also observed in older adults, women, and those with chronic migraine or migraine without aura.”
This study presented a broad overview of the comparison of the potential effectiveness of two drug groups in preventing glaucoma. While this study shows a promising correlation between reduced risk of developing glaucoma when some individuals use specific CGRPi drugs, more directed and focused studies would be required to confirm a causative impact of CGRPi treatment reducing glaucoma risk.
“Further studies are needed to confirm these results, but the findings may help us better understand both migraine and glaucoma,” confirmed Weng.
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