When Lighting Strikes: The Effect of Light Sensitivity on Migraine

What do approximately 90% of people with migraine have in common? If you guessed a sensitivity to light either before, during and/or after their attacks, then you would be correct. Even with the highly-individualized experiences associated with migraine, light sensitivity—or photophobia as it can be called—remains a familiar frustration shared by many.

Social media is just one outlet where patients express the pain that light can cause:

“I’m so concerned about my light sensitivity. Should I move into a cave just to evade a migraine??” – Dani

“My migraines don’t go anywhere without their best friends, industrial strength nausea and light sensitivity that mimics staring directly into a car’s high beams” – @sallyt

If these comments describe your own dealings with photophobia, you are not alone. In fact, as we describe below, it is one of the more reliable symptoms of migraine. But it is also one with options for relief.

Light Sensitivity During Each Stage of a Migraine Attack

Light sensitivity and photophobia follow patients in all phases of the migrainous period. In the early stages of an attack (known as the prodrome), this strong aversion to light may affect up to 79% of people according to research.1 

Many acknowledge that they feel a heightened sensitivity to their environment during this time, perhaps signaling that photophobia is actually a warning sign of the forthcoming attack. 

The trend continues among those who experience aura too, with perhaps as many as 88% identifying photophobia as one of their regular aura symptoms.2 This often manifests alongside other visual disturbances.

In addition, bright light has been cited a pre-attack trigger for at least one-third of people with migraine, although it is likely underreported. Artificial light—fluorescents, digital screens—as well as sunlight are the most likely sources to bring on an attack. Experts believe a myriad of factors contribute to these outcomes, including:

• Brightness levels: even those without a headache disorder might react negatively to extremely bright light. However, people with migraine are known to have a lower threshold for light overall, making any exposure to an intense light source a cause for concern.

• Blue-green light: certain cells in our eyes are more sensitive to wavelengths of blue-green light, which are ever-present in many familiar light sources. These cells, called photosensitive retinal ganglion cells, then transmit pain and other sensory signals to the brain. This may be furthered by additional central nervous system dysfunction linked to migraine.

• Flickering light: rapid, flashing lights (such as emergency vehicle or concert lighting) is lamented by those with migraine, and researchers have suggested that the sharp contrast between dark and light triggers activity in the brain.

During the attack or headache phase, photophobia is the second most frequent symptom after actual head pain. For these reasons, it has become one of the hallmark features of the headache disorder and is included in clinical definitions of migraine. Exposure to light during the attack can make other symptoms worse too, leading to more pain and even extending the recovery time. This explains why many choose to wear sunglasses indoors or find temporary solace in a dark space. In addition, migraine symptoms can be misleading and vary from one episode to the next; you may not experience photophobia as part of every attack, but that does not mean you are not light sensitive.  

Fortunately, there may be a slight respite during the postdrome or post-attack phase of migraine, although light sensitivity still remains a regular symptom for approximately 36% of individuals.3 This is consistent with other research that shows the presence of constant photophobia between attacks. Ultimately, the picture emerges that people with migraine-related photophobia are highly sensitive to external stimuli just about all the time.

Why Light Sensitivity Must Be Addressed

The physical pain of photophobia is no doubt unpleasant, but other factors also emphasize the need for providing effective solutions for this issue. 

We know that people who have been diagnosed with migraine—especially chronic migraine—are more likely to deal with emotional hardships. However, the presence of light sensitivity seems to accentuate issues of depression, anxiety, irritability, and other psychological symptoms. One of the main reasons has to do with the avoidance behaviors in which people with migraine frequently engage. For example, they may opt to forego social or professional activities for fear that light may trigger an attack; or they might disengage from social media because they are sensitive to screen light. Regardless, missing out on these important life events can intensify feelings of isolation and lead to further negative outcomes.

This is why we must encourage people with migraine to get out of the dark if they are able! We continue to see advancements in the tools available to address light sensitivity, such as:

• Light-filtering mobile applications (e.g. f.lux)

• Tinted eyewear for indoors (e.g. FL-41 tint)

• New treatments for migraine prevention (e.g. CGRP drugs)

These can all help turn down the relative “intensity” of photophobia and ultimately allow people to reclaim their freedom from the darkness—and the light.

References:

1Laurell K, Artto V, Bendtsen L, Hagen K, Häggström J, Linde M, Söderström L, Tronvik E, Wessman M, Zwart JA, Kallela M. Premonitory symptoms in migraine: A cross-sectional study in 2714 persons. Cephalalgia. 2016 Sep;36(10):951-9. doi: 10.1177/0333102415620251. Epub 2015 Dec 6.

2Hansen JM, Lipton RB, Dodick DW, et al. Migraine headache is present in the aura phase: a prospective study. Neurology. 2012;79(20):2044-9.

3Giffin NJ, Lipton RB, Silberstein SD, Olesen J, Goadsby PJ. The migraine postdrome: An electronic diary study. Neurology. 2016;87(3):309-13.

“Greg Bullock is the marketing manager at TheraSpecs. He also publicly advocates for individuals with migraine, helping to raise awareness around key issues within the patient community.”