Friday, March 31, 2023
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This activity is intended for psychiatrists, family medicine and primary care clinicians, internists, neurologists, ophthalmologists, nurses/nurse practitioners, physician assistants, pharmacists, and other members of the health care team for patients with migraine and/or insomnia.
The goal of this activity is for learners to be better able to describe the correlation between computer vision syndrome, insomnia, and migraine, taking into consideration stress as a mediating factor between these variables, based on a cross-sectional study conducted between August 2020 and April 2021.
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CME / ABIM MOC / CE Released: 10/28/2022
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Digital display terminals are now an integral part of daily routine. Increased screen use time may cause health problems, particularly computer vision syndrome (CVS) and insomnia.
Blue light from computer screens can interfere with normal circadian rhythm by inhibiting melatonin secretion and can cause digital eyestrain and migraine attacks. Stress induces insomnia, triggers migraine, and increases risk for development of chronic migraine.
Computer vision syndrome (CVS, a condition involving eye problems resulting from screen time with digital devices, is significantly associated with both insomnia and migraine, with stress as a central mediating factor, new research suggests.
Investigators administered an online questionnaire to more than 700 adults, of whom 70.5% had CVS. Results showed that the presence of CVS and higher stress were significantly associated with higher odds of having migraine, with stress mediating the association between CVS and migraine and between CVS and insomnia.
"This study would help practicing clinicians in preventing [CVS] by counseling patients about the importance of taking breaks when using a computer," senior investigator Souheil Hallit, PharmD, MSc, MPH, associate professor, School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, Jounieh, Lebanon, told Medscape Medical News.
"Other preventive measures can also be taken, such as adjusting the screen brightness to the room lighting, using screen filters, and practicing good ergonomics," said Dr Hallit, who is also the director of the Psychiatric Hospital of the Cross in Beirut.
Public Health Issue
"Computer and visual display terminals have become an integral part of our daily routines," the researchers write. However, the increased screen time "may lead to deleterious health disorders, especially eye problems," known as CVS, they add.
In addition, the recent increase in online teaching in answer to the COVID-19 pandemic has made CVS an "important public health issue," they note.
Prolonged use of digital devices can lead to a wide variety of symptoms including itching, blurred or double vision, eye pain, headache, backache, neck or shoulder pain, and numbness of the hands or fingers. Extensive computer use can also lead to insomnia.
In addition, "blue light" emitting from computer screens can interfere with the normal circadian rhythm, causing digital eyestrain and insomnia, the investigators note.
Stress is another trigger for migraine attacks and is also a risk factor for the development of chronic migraine from episodic migraine, they add. Plus, stressful life events can induce insomnia.
"We chose to conduct this study because computer use has become essential to our daily lives. In addition, CVS prevalence is increasing in other populations and there are no Lebanese studies available in this regard," Dr Hallit said.
"We also thought that shedding light on the existence of this syndrome would help implement preventive measures to minimize the high prevalence of CVS among computer users," he added.
The researchers administered an online questionnaire to all digital device users from all districts of Lebanon, with data collection taking place during the government-imposed COVID-19 lockdown.
The 749 study participants (mean age, 24.51 years; 65.6% women) were recruited using a snowball sampling technique, wherein links were sent to individuals via WhatsApp and email. In addition, participants were asked to send the link to other individuals who use digital devices.
The questionnaire consisted of both closed and semi-open questions, including sociodemographic characteristics; ocular health problems; how participants used their computer screens; their cumulative number of hours of computer use; the Computer Vision Syndrome Scale, consisting of 16 symptoms related to improper computer usage; the Migraine Disability Assessment Scale (MIDAS); the Lebanese Insomnia Scale (LIS-18); and the Beirut Distress Scale (BDS-10).
Most Disturbing Symptom
Results showed that 70.5% of participants had CVS. Headache was reported as "the most disturbing ocular symptom" (34.0%), followed by eye burning (10.8%). The most disturbing extraocular symptoms were neck pain and backache (43.3% and 33.4%, respectively).
After analyzing factors associated with insomnia, the investigators found that significantly more women than men experienced insomnia (P=.041). Insomnia was also more common in participants with a higher level of education (P<.001), with CVS (P=.003), with higher stress (P<.001), with a higher Household Crowding Index (P<.01), and with greater migraine disability (P<.01).
A multivariable analysis using a linear regression model and taking the insomnia score as the dependent variable showed that presence of CVS (β=3.26) was significantly associated with a higher rate of insomnia.
The researchers also analyzed factors associated with migraine and found that a significantly higher percentage of participants with migraine were women than men (51.3% vs 41.5%, respectively; P=.01) and had CVS vs no CVS (53.8% vs 35.7%; P=.001).
Notably, those with migraine had a higher mean stress score compared with those with a lower stress score (13.90 vs 9.92, respectively; P<.001).
CVS and higher stress were significantly associated with higher odds of having migraine, as shown in the following table:
|
Variable |
aOR for Migraine (95% CI) |
P Value |
|---|---|---|
|
CVS |
1.66 (1.07-2.59) |
.024 |
|
Higher stress |
1.09 (1.06-1.12) |
<.001 |
A mediation analysis showed that stress mediated the association between CVS and migraine by 53%, and between CVS and insomnia by 80%.
Dr Hallit noted that the study "may assist physicians" in managing insomnia.
"By focusing on the fact that using the computer just before going to bed, especially while experiencing stressful life events, is associated with insomnia, doctors can treat insomnia without the need for medications," he said.
"Moreover, finding that screen headache is the most commonly disturbing symptom of CVS would help physicians treat headache nonpharmacologically with certain preventive measures, such as wearing blue light filtering when using a computer screen," Dr Hallit added.
Modifiable Risk
Alison Thaler, MD, assistant professor of neurology, Icahn School of Medicine at Mount Sinai, New York City, and an editorial board member of the American Migraine Foundation, noted that stress is a "major risk factor for migraine."
It can also "lead to poor posture while we work at a computer, which, over time, can activate trigger points in neck and shoulder muscles that can trigger migraine," said Dr Thaler, who was not involved with the research.
For that reason, "it makes sense that higher stress levels may strengthen the connection between CVS and migraine. The worse the stress, the more likely CVS is to be linked to migraine," she said.
Dr Thaler added that understanding the relationship between screen time and migraine is important because it can be modified.
"We can limit screen time when possible, avoid screen time before bed, and use blue light filtering glasses to help prevent CVS from causing migraine attacks," she said.
However, she noted that the study was associational and does not establish a causal relationship between CVS and migraine.
"Future studies are needed to further clarify the relationship between screen time and migraine," Dr Thaler said.
No source of study funding was listed. The investigators and Dr Thaler have disclosed no relevant financial relationships.
Prim Care Companion CNS Disord. Published online August 11, 2022.[1]
