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Photophobia: When Light Hurts, a Review

  • Headache (R B Halker, Section Editor)
  • Published:
Current Neurology and Neuroscience Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

To provide an updated overview of Photophobia with a particular focus on photophobia related to migraine.

Recent Findings

Melanopsin-containing photoreceptors called intrinsically photosensitive retinal ganglion cells (ipRGCs) have been identified in the retina and explain the rational for photophobia in individuals who are blind.

Summary

Photophobia, a sensory disturbance provoked by light, is a common neurological and ophthalmological symptom. Migraine, a common neurological condition, is pathognomonic of photophobia; however, other primary headache conditions, traumatic brain injury, and impairment of the optic pathway can cause photophobia. In addition, anterior and posterior segment ocular pathology, medications, and psychiatric conditions can result in photophobia. At least 2 (possibly three) distinct neural pathways are involved in photophobia. Some of the basic science regarding these pathways is discussed in this review including the role of calcitonin gene-related peptide (CGRP) and pituitary adenylate cyclase-activating polypeptide. Management of photophobia includes treatment of the underlying etiology and conservative strategies such as wearing sunglasses.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. HCCotI H. The international classification of headache disorders, 3rd edition (beta version). Cephalalgia. 2013;

  2. Digre KB, Brennan K. Shedding light on photophobia. J Neuroophthalmol. 2012;32(1):68–81.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Rose FC. The history of migraine from Mesopotamian to medieval times. Cephalalgia. 1995;15(Suppl 15):1–3.

    PubMed  Google Scholar 

  4. Ahn AH, Brennan K. Headache currents unanswered questions in headache. Headache. 2013;53(10):1673–4.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Lebensohn JE, Bellows J. The nature of photophobia. Arch Ophthalmol. 1934;12(3):380–90.

    Article  Google Scholar 

  6. Cummings JL, Gittinger JW Jr. Central dazzle. A thalamic syndrome? Arch Neurol. 1981;38(6):372–4.

    Article  PubMed  CAS  Google Scholar 

  7. Wu Y, Hallett M. Photophobia in neurologic disorders. Translational Neurodegeneration. 2017;6:26.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Choi JY, Oh K, Kim BJ, Chung CS, Koh SB, Park KW. Usefulness of a photophobia questionnaire in patients with migraine. Cephalalgia : an International Journal of Headache. 2009;29(9):953–9.

    Article  Google Scholar 

  9. Robbins MS, Lipton RB. The epidemiology of primary headache disorders. Semin Neurol. 2010;30(2):107–19.

    Article  PubMed  Google Scholar 

  10. Drummond PD, Woodhouse A. Painful stimulation of the forehead increases photophobia in migraine sufferers. Cephalalgia : an International Journal of Headache. 1993;13(5):321–4.

    Article  CAS  Google Scholar 

  11. Vincent AJ, Spierings EL, Messinger HB. A controlled study of visual symptoms and eye strain factors in chronic headache. Headache. 1989;29(8):523–7.

    Article  PubMed  CAS  Google Scholar 

  12. Good PA, Taylor RH, Mortimer MJ. The use of tinted glasses in childhood migraine. Headache. 1991;31(8):533–6.

    Article  PubMed  CAS  Google Scholar 

  13. Drummond PD. A quantitative assessment of photophobia in migraine and tension headache. Headache: The Journal of Head and Face Pain. 1986;26(9):465–9.

    Article  CAS  Google Scholar 

  14. Main A, Vlachonikolis I, Dowson A. The wavelength of light causing photophobia in migraine and tension-type headache between attacks. Headache. 2000;40(3):194–9.

    Article  PubMed  CAS  Google Scholar 

  15. Irimia P, Cittadini E, Paemeleire K, Cohen AS, Goadsby PJ. Unilateral photophobia or phonophobia in migraine compared with trigeminal autonomic cephalalgias. Cephalalgia : an International Journal of Headache. 2008;28(6):626–30.

    Article  CAS  Google Scholar 

  16. Cittadini E, Goadsby PJ. Hemicrania continua: a clinical study of 39 patients with diagnostic implications. Brain. 2010;133(Pt 7):1973–86.

    Article  PubMed  Google Scholar 

  17. Vanagaite J, Pareja JA, Storen O, White LR, Sand T, Stovner LJ. Light-induced discomfort and pain in migraine. Cephalalgia : an international journal of headache. 1997;17(7):733–41.

    Article  CAS  Google Scholar 

  18. Vingen JV, Pareja JA, Stovner LJ. Quantitative evaluation of photophobia and phonophobia in cluster headache. Cephalalgia : an International Journal of Headache. 1998;18(5):250–6.

    Article  CAS  Google Scholar 

  19. Kawasaki A, Kardon RH. Intrinsically photosensitive retinal ganglion cells. Journal of Neuro-Ophthalmology : the Official Journal of the North American Neuro-Ophthalmology Society. 2007;27(3):195–204.

    Article  Google Scholar 

  20. Provencio I, Jiang G, De Grip WJ, Hayes WP, Rollag MD. Melanopsin: an opsin in melanophores, brain, and eye. Proc Natl Acad Sci. 1998;95(1):340–5.

    Article  PubMed  CAS  Google Scholar 

  21. Xue T, Do MTH, Riccio A, Jiang Z, Hsieh J, Wang HC, et al. Melanopsin signaling in mammalian Iris and retina. Nature. 2011;479(7371):67–73.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  22. Noseda R, Kainz V, Jakubowski M, Gooley JJ, Saper CB, Digre K, et al. A neural mechanism for exacerbation of headache by light. Nat Neurosci. 2010;13(2):239–45.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  23. Johnson J, Wu V, Donovan M, Majumdar S, Renteria RC, Porco T, et al. Melanopsin-dependent light avoidance in neonatal mice. Proc Natl Acad Sci. 2010;107(40):17374–8.

    Article  PubMed  Google Scholar 

  24. Matynia A, Parikh S, Chen B, Kim P, McNeill DS, Nusinowitz S, et al. Intrinsically photosensitive retinal ganglion cells are the primary but not exclusive circuit for light aversion. Exp Eye Res. 2012;105:60–9.

    Article  PubMed  CAS  Google Scholar 

  25. Okamoto K, Thompson R, Tashiro A, Chang Z, Bereiter DA. Bright light produces Fos-positive neurons in caudal trigeminal brainstem. Neuroscience. 2009;160(4):858–64.

    Article  PubMed  CAS  Google Scholar 

  26. Maleki N, Becerra L, Upadhyay J, Burstein R, Borsook D. Direct optic nerve pulvinar connections defined by diffusion MR tractography in humans: implications for photophobia. Hum Brain Mapp. 2012;33(1):75–88.

    Article  PubMed  Google Scholar 

  27. Dolgonos S, Ayyala H, Evinger C. Light-induced trigeminal sensitization without central visual pathways: another mechanism for photophobia. Invest Ophthalmol Vis Sci. 2011;52(11):7852–8.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Burstein R, Yamamura H, Malick A, Strassman AM. Chemical stimulation of the intracranial dura induces enhanced responses to facial stimulation in brain stem trigeminal neurons. J Neurophysiol. 1998;79(2):964–82.

    Article  PubMed  CAS  Google Scholar 

  29. Noseda R, Burstein R. Advances in understanding the mechanisms of migraine-type photophobia. Curr Opin Neurol. 2011;24(3):197–202.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Amini A, Digre K, Couldwell WT. Photophobia in a blind patient: an alternate visual pathway. Case report J Neurosurg. 2006;105(5):765–8.

    PubMed  Google Scholar 

  31. • Rossi HL, Recober A. Photophobia in primary headaches. Headache. 2015;55(4):600–. Excellent review of the pathways involved with photophobia including second, third and fourth order neurons as well as calcitonin gene related peptide and pituitary adenylate cyclase-activating polypeptide.–4.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Sprenger T, Goadsby PJ. Migraine pathogenesis and state of pharmacological treatment options. BMC Med. 2009;7(1):71.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  33. Kaiser EA, Kuburas A, Recober A, Russo AF. Modulation of CGRP-induced light aversion in wild-type mice by a 5-HT(1B/D) agonist. J Neurosci. 2012;32(44):15439–49.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  34. Markovics A, Kormos V, Gaszner B, Lashgarara A, Szoke E, Sandor K, et al. Pituitary adenylate cyclase-activating polypeptide plays a key role in nitroglycerol-induced trigeminovascular activation in mice. Neurobiol Dis. 2012;45(1):633–44.

    Article  PubMed  CAS  Google Scholar 

  35. Evans RW, Seifert T, Kailasam J, Mathew NT. The use of questions to determine the presence of photophobia and phonophobia during migraine. Headache: The Journal of Head and Face Pain. 2008;48(3):395–7.

    Article  Google Scholar 

  36. Bossini LVM, Padula L, De Capua A, Pacchierotti C. P C. Sensibilità alla luce e psicopatologia: validazione del Questionario per la Valutazione della Fotosensibilità (QVF). Medicina Psicosomatica. 2006;51:167–76.

    Google Scholar 

  37. Edvinsson L, Villalon CM, MaassenVanDenBrink A. Basic mechanisms of migraine and its acute treatment. Pharmacol Ther. 2012;136(3):319–33.

    Article  PubMed  CAS  Google Scholar 

  38. Bigal ME, Bordini CA, Tepper SJ, Speciali JG. Intravenous magnesium sulphate in the acute treatment of migraine without aura and migraine with aura. A randomized, double-blind, placebo-controlled study. Cephalalgia. 2002;22(5):345–53.

    Article  PubMed  CAS  Google Scholar 

  39. Peikert A, Wilimzig C, Kohne-Volland R. Prophylaxis of migraine with oral magnesium: results from a prospective, multi-center, placebo-controlled and double-blind randomized study. Cephalalgia. 1996;16(4):257–63.

    Article  PubMed  CAS  Google Scholar 

  40. Koseoglu E, Talaslioglu A, Gonul AS, Kula M. The effects of magnesium prophylaxis in migraine without aura. Magnes Res. 2008;21(2):101–8.

    PubMed  CAS  Google Scholar 

  41. von Luckner A, Riederer F. Magnesium in migraine prophylaxis-is there an evidence-based rationale? A systematic review. Headache. 2018;58(2):199–209.

    Article  Google Scholar 

  42. Diel RJ, Kroeger ZA, Levitt RC, Sarantopoulos C, Sered H, Martinez-Barrizonte J, et al. Botulinum toxin a for the treatment of photophobia and dry eye. Ophthalmology. 2018;125(1):139–40.

    Article  PubMed  Google Scholar 

  43. • Katz BJ, Digre KB. Diagnosis, pathophysiology, and treatment of photophobia. Surv Ophthalmol. 2016;61(4):466–. This review article discusses melanopsin-containing intrinsically photosensitive retinal ganglion cells (ipRGCs) as a culprit in photophobia.–77.

    Article  PubMed  Google Scholar 

  44. Karanovic O, Thabet M, Wilson HR, Wilkinson F. Detection and discrimination of flicker contrast in migraine. Cephalalgia. 2011;31(6):723–36.

    Article  PubMed  PubMed Central  Google Scholar 

  45. Hallett M, Evinger C, Jankovic J, Stacy M. Update on blepharospasm: report from the BEBRF International Workshop. Neurology. 2008;71(16):1275–82.

    Article  PubMed  PubMed Central  Google Scholar 

  46. Blackburn MK, Lamb RD, Digre KB, Smith AG, Warner JE, McClane RW, et al. FL-41 tint improves blink frequency, light sensitivity, and functional limitations in patients with benign essential blepharospasm. Ophthalmology. 2009;116(5):997–1001.

    Article  PubMed  PubMed Central  Google Scholar 

  47. Fine PG, Digre KB. A controlled trial of regional sympatholysis in the treatment of photo-oculodynia syndrome. J Neuroophthalmol. 1995;15(2):90–4.

    Article  PubMed  CAS  Google Scholar 

  48. Young W, Cook B, Malik S, Shaw J, Oshinsky M. The first 5 minutes after greater occipital nerve block. Headache. 2008;48(7):1126–8.

    Article  PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

  1. Division of Neurology, University of British Columbia, 8219-2775 Laurel Street, Vancouver, British Columbia, V5Z 1M9, Canada

    Abdul Albilali & Esma Dilli

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  1. Abdul Albilali
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  2. Esma Dilli
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Correspondence to Esma Dilli.

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Conflict of Interest

Abdul Albilali declares no conflict of interest.

Esma Dilli has received honoraria from Allergan and paid travel accommodations from Novartis.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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This article is part of the Topical Collection on Headache

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Albilali, A., Dilli, E. Photophobia: When Light Hurts, a Review. Curr Neurol Neurosci Rep 18, 62 (2018). https://doi.org/10.1007/s11910-018-0864-0

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