migraine is a chronic disease of the brain that enhances morbidity with complains like photophobia , headache attacks , phonophobia , and nausea . in the second edition of the headache classification by the international headache society , migraine is among the primary headaches and migraine without aura , migraine with aura , migraine cursors in childhood , retinal migraine , and migraine complications are grouped as potential migraines . according to the results of the turkish headache database , the number of female patients is 4 times that of male patients . there were 84% of the adults who were migraine without aura patients , and 14% who were migraine with aura patients . although most of these patients have been found to have comorbidity with other diseases , eye diseases were excluded from those studies ; however , photophobia is reported to be the most frequent accompanying symptoms . the vision system is reported to play a role , especially in migraine with aura headaches . one of 5 patients with a headache is directed to the department of eye diseases , mostly because almost all migraine with aura patients have visual auras . the relationship between migraine and refractive errors has been studied for more than 100 years ; however , conflicting results have emerged from those studies [ 79 ] . in this study , we compared the auto - refractometric values of migraine patients with and without visual aura , with those patients without migraine complaints . we prospectively compared the patients who consulted the neurology policlinic between june 2013 and march 2014 with a headache complaint and diagnosed with migraine in accordance with the ichd-2 criterion with the individuals of the same gender and age group with no headache complaint . this study adhered to the tenets of the declaration of helsinki and was carried out with the approval of the institution . the patients were given full detailed eye examinations and findings were noted . out of these patients , those over age 18 years who had 20/20 uncorrected vision and who did not have ocular pathology in their examination were included in the study . the patients were divided into 3 groups : group 1 : 86 eyes of 43 migraine patients without aura ; group 2 : 38 eyes of 19 migraine patients with aura ; and group 3 : 60 eyes of 30 patients without headache . the same ophthalmologist examined the patients in the period with no headache . the corrected and uncorrected vision of right eye and left and bilateral eye of all the patients were individually measured . those patients whose uncorrected vision did not have 20/20 value for both eyes separately and bilaterally were excluded from the study . the 3-dimensional vision and eye movements of the patients were evaluated by the worth 4-point test and those patients who failed this test were excluded from the study . biomicroscopic and fundus examinations of the patients were carried out and the intraocular pressure values were measured with goldmann applanation tonometry ; those patients with ocular pathology were excluded from the study . before the eye examination , following the eye examinations , 45 minutes after the patients were given 1% cyclopentolate hcl drips 3 times with 5 minutes intervals , their auto - refractometry values were recorded again . the intended purpose of using the cyclopentolate with mydriatic and cycloplegic effect was that with the cycloplegic effect , ciliary muscles contraction was hindered and refractivity of the lenses increases through cambering ; in other words , accommodation was hindered . thus , we aimed to provide more accurate refractivity values for the eye structures . in the study , spherical equivalents ( se ) and cycloplegic spherical equivalents ( cse ) from the auto - refractometrical values of the patients were used . spherical equivalent is equal to the sum of the sphere value and half the cylindrical value , which were measured by the auto - refractometer device . data were analyzed using spss ( statistical package for social sciences ) for windows 17.0 software . for quantitative data to compare the groups with normal distribution of parameters , we prospectively compared the patients who consulted the neurology policlinic between june 2013 and march 2014 with a headache complaint and diagnosed with migraine in accordance with the ichd-2 criterion with the individuals of the same gender and age group with no headache complaint . this study adhered to the tenets of the declaration of helsinki and was carried out with the approval of the institution . the patients were given full detailed eye examinations and findings were noted . out of these patients , those over age 18 years who had 20/20 uncorrected vision and who did not have ocular pathology in their examination were included in the study . the patients were divided into 3 groups : group 1 : 86 eyes of 43 migraine patients without aura ; group 2 : 38 eyes of 19 migraine patients with aura ; and group 3 : 60 eyes of 30 patients without headache . the corrected and uncorrected vision of right eye and left and bilateral eye of all the patients were individually measured . those patients whose uncorrected vision did not have 20/20 value for both eyes separately and bilaterally were excluded from the study . the 3-dimensional vision and eye movements of the patients were evaluated by the worth 4-point test and those patients who failed this test were excluded from the study . biomicroscopic and fundus examinations of the patients were carried out and the intraocular pressure values were measured with goldmann applanation tonometry ; those patients with ocular pathology were excluded from the study . before the eye examination , 45 minutes after the patients were given 1% cyclopentolate hcl drips 3 times with 5 minutes intervals , their auto - refractometry values were recorded again . the intended purpose of using the cyclopentolate with mydriatic and cycloplegic effect was that with the cycloplegic effect , ciliary muscles contraction was hindered and refractivity of the lenses increases through cambering ; in other words , accommodation was hindered . thus , we aimed to provide more accurate refractivity values for the eye structures . in the study , spherical equivalents ( se ) and cycloplegic spherical equivalents ( cse ) from the auto - refractometrical values of the patients were used . spherical equivalent is equal to the sum of the sphere value and half the cylindrical value , which were measured by the auto - refractometer device . data were analyzed using spss ( statistical package for social sciences ) for windows 17.0 software . for quantitative data to compare the groups with normal distribution of parameters , forty - three ( 69% ) out of the total of 62 patients had migraine without aura and 19 of them ( 31% ) had aura migraine . age , gender distribution , and auto - refractometrical values of the migraine and control patients are given in table 1 . although the cycloplegic spherical equivalents results of the right eyes were not statistically significant , statistical significance was found in the tukey test between the migraine patients with aura and the control group ( p=0.05 ) . the right and left eyes of the patients were evaluated together and a significant correlation was found between the groups . it was also found through the tukey test that the source of significance was patients with aura ( p=0.010 ) . when the refractive value differences between both eyes were evaluated , no significant difference was found in se and cse measurements ( p=0.411 and 0.536 ) . to evaluate the impact of cycloplegia in patients , se and cse values were obtained and differences between these values were evaluated . in the post hoc tukey test , it was found that the change in group 2 patients was significantly lower than the change in group 3 patients ( p=0.024 ) . the differences between cse and se in all eyes in both groups are given in table 3 . ninety - nine percent of migraine patients with aura had visual symptoms . it was observed that since visual auras such as photopsy , scintillating scotoma , and hemianosmic changes in the foreground , especially in migraine with aura , the potential ocular problems in migraine pathogenesis have to be taken into account and the patients consulting with headaches were referred to ophthalmologists . we give eye examination to the migraine patients referred to our policlinics from the department of neurology and evaluated their examination findings . there are studies stating that migraine - related findings and refraction defects can trigger migraine . it was reported that migraine may impact the eyelids , conjunctiva , iris , pupil , optical nerve , retina , and extraocular muscles . the relationship between the refractive errors and migraine has been researched since the beginning of the 20 century . although these studies especially emphasized that anisometropia and astigmatism were the triggers of migraine , the value of their results were limited because they were not controlled studies and no statistical evaluation was made [ 79 ] . emphasized that blurry vision generated by astigmatism could create a hyperexcitability on the visual cortex and this could be a triggering factor for migraine . when the migraine patients in our study were compared with the same age and gender groups , the spherical equivalents were found to be the same , but the cycloplegic spherical equivalents were significantly lower . when the migraine patients are divided into groups with and without aura and evaluated this way , while se values of the patient group with aura were similar to the control group , their cse values were significantly lower . compatible with this finding , it was found that the changes in migraine patients with aura between the measurements before and after eye drops ( 1% cyclopentolate hcl ) were significantly lower . similar to our study , there are studies demonstrating that the refractive errors were not different in migraine patients and it was also suggested in these studies that binocular vision was important . however , even though we found no significant difference in refractive values between the 2 eyes in our study , all the patients involved in the study had 3-dimensional and uncorrected 20/20 vision . the fact that the cycloplegic refraction values , especially in patients with aura , were found to be lower in comparison to healthy individuals could be an indication that these patients did not make sufficient accommodation . since these patients could have blurry vision and difficulty focusing , it should be noted that this could be the trigger of a headache . on the other hand , no anisocoria was found in any of our patients ; however , we failed to measure the pupil diameters since we did not have a pupillometer . it is possible that lack of accommodation in addition to isochoric and mydriatic pupils may create an attack with the increase in the amount of light entering the retina . it was found in the previous studies that visual stimulus triggered a migraine in more than 1/3 of the patients and that the migraines triggered by light decreased in patients who were given colored lenses during the migraine attack . bright light was a triggering factor in 87% of the migraine patients with aura , and this rate was 76% in migraine patients without aura . the general characteristic of this condition is that with the third cranial nerve the most affected , it is accompanied by ocular cranial nerve palsy together with the migraine - like headaches in the form of attacks . in these situations , in which the pathophysiology is not fully understood in 75% of the patients , there was contrast increase and thickening in the mri - scanned nerves during the attacks , and it was thought that there might be an accompanying migraine or independent neuropathy . in another study , in a spect - scanned nerve area , a low level of blood flow was detected and it was thought that a temporary ischemic attack might follow . in addition , ciliary ganglion cells or migraine - related elongated mydriasis might have occurred as a result of temporary dysfunctioning of postganglionic and parasympathetic fibers during a migraine attack . the researchers who coined the term sillier ganglioplegic for this particular situation stated that this might be another result of ophthalmoplegic migraine pathogenesis . according to this hypothesis , the cause of ophthalmoplegic migraine may also cause elongated mydriasis by clinging to the parasympathetic fibers . in the same study , it was stated that , in theory , the pain stemming from the sillier ganglions may find its way to the ophthalmic region of the trigeminal nerve and may create a bilateral headache . based on this study , it is possible to conclude that innervation deterioration in the sillier ganglions into the sillier muscle in these patients may cause insufficient accommodation . however , it was not possible to evaluate these hypotheses in our study since there were insufficient numbers of migraine patients with aura ; they were evaluated during the remission period and no mri tests were carried out . we are of the opinion that the main causes of these conflicting results are misdiagnosis of headaches , changes in the diseases classification due to the new diagnostic techniques , evaluation of all the migraine patients together , and the lump - sum evaluation of all the eye impairments and visual levels . to keep our study free of such handicaps , we only evaluated the patient with uncorrected 20/20 vision , dividing them into groups with and without aura . we found that the cycloplegic spherical equivalent values of our patients with aura were lower than in control patients . however , given the fact that our findings were obtained from the eye examinations of the patients during the remission period , it is not possible to determine whether migraine with aura is the trigger or the result of those attacks . however , the number of migraine patients with aura is less than those without aura and it is very difficult to detect by the patient s ophthalmologist during the attack period . in order to be more conclusive about this particular issue , the neurologist and ophthalmologist should be in communication and there is a need for more comprehensive studies with larger number of participants .
backgroundthe aim of this study was to compare spherical equivalents ( se ) and spherical equivalents with cycloplegic ( cse ) values of migraine patients with and without visual aura , with those patients without migraine complaints.material/methodswe included patients over the age of 18 years , who had 20/20 uncorrected vision , and who did not have ocular pathology in their examination . 
 the patients were divided into 3 groups : group 1 : 86 eyes of 43 migraine patients without aura , group 2 : 38 eyes of 19 migraine patients with aura , and group 3 : 60 eyes of 30 patients without migraine . 
 spherical equivalents and spherical equivalents with cycloplegic from the auto - refractometrical values of the patients were compared.resultsthe mean age of the migraine and control patients was 34.28.3 and 33.610.8 years , respectively . 
 forty - three ( 69% ) of 62 migraine patients had migraine without aura and 19 ( 31% ) had migraine with aura . 
 the right and left eyes of the patients were evaluated together and a significant correlation was found between the groups . to evaluate 
 the impact of cycloplegia in patients , se and cse values were obtained and differences between these values were evaluated . 
 it was found that the change in group 2 patients was significantly lower than the change in group 3 patients ( p=0.024).conclusionswe found that the cycloplegic spherical equivalents values of our patients with aura were lower than control patients . 
 we need further studies to reveal whether migraine with aura is the trigger or the result of those attacks .