Decoding Visual Symptoms in Migraine: The Role of Binocular Vision Abnormalities: A Cross-sectional Study

Introduction: Migraine is a chronic, neurovascular disorder characterised by recurrent attacks of headaches. Migraine is also associated with a variety of symptoms, including sensitivity to light, sound, and smell, as well as nausea, dizziness, difficulty concentrating, and fatigue. Accommodative issues can manifest as blurred vision at distance and/or near, headaches, poor concentration, and reading difficulties. There is a relationship between binocular vision impairments and migraine headaches, as both conditions can produce visual symptoms that diminish a patient’s overall quality of life. Aim: To quantify visual symptoms and their correlation with specific binocular vision dysfunctions in a cohort of migraine patients. Materials and Methods: This cross-sectional study was conducted at Yenepoya Medical College, Mangaluru, Karnataka, India, from June 2024 to January 2025. The study included 72 migraine patients (with or without aura), diagnosed with specific binocular vision anomalies such as Accommodation Insufficiency (AI), Convergence Insufficiency (CI), Accommodation Excess (AE), or Convergence Excess (CE). Visual symptoms of all 72 patients were assessed using the 14-item Symptom Questionnaire for Visual Dysfunctions (SQVD). Scores were categorised into mild, moderate, and severe using a predefined percentage-based cut-off derived from principles often applied in knowledge/ attitude/practice assessments. Statistical analyses included one-way Analysis of Variance (ANOVA) and regression analysis to examine relationships between visual symptom scores and binocular vision anomalies, age, and gender. Results: The cohort comprised predominantly females 64 (89%) with a mean age of 22.29±2.67 years. The average SQVD score was 10.08±4.14. The severity distribution indicated that 52 (72.2%) experienced mild, 16 (22.2%) moderate, and 4 (5.6%) severe visual symptoms. A one-way ANOVA revealed no statistically significant difference in visual symptom scores among the four binocular anomaly groups (p-value=0.454). Regression analysis identified age as a significant negative predictor of visual symptom scores (β=-0.4, p-value=0.035), indicating that scores decreased with increasing age. Binocular anomaly types and gender were not statistically significant predictors. Conclusion: Visual symptoms are prevalent among young adult migraine patients, with photophobia often being a major contributor. While binocular vision anomalies frequently coexist with migraine, this study found no statistically significant correlation between specific binocular vision dysfunction types and overall visual symptom severity as measured by the SQVD. Further research is warranted to explore the complex interplay of various visual disturbances in migraine and their impact on quality of life, particularly considering age-related trends and the distinct pathophysiology of photophobia.