Photophobia Linked to Psychiatric Comorbidities in Migraineurs and Controls

As many as 80% of patients with migraine experience photophobia, which can occur during or between attacks.

Researchers from the Medical University of Vienna discovered higher rates of depression, anxiety, and stress in both patients with migraine and migraine-free control patients with photophobia. Their findings were recently published in the Journal of Headache and Pain.¹

As many as 80% of migraine patients experience photophobia, which can occur during or between attacks.^2,3 In addition, prior research points to a link between migraine and psychiatric comorbidities such as depression and anxiety, and a recent study found higher scores on the Beck Depression Inventory and the Beck Anxiety Inventory in patients with vs without interictal photophobia.^4,5

While recruiting patients for a new functional magnetic resonance imaging (fMRI) study on photophobia in migraineurs, the investigators observed higher rates of psychiatric comorbidities in this group than they anticipated. This observation prompted them to examine the association between photophobia and psychometric variables in these patients.

Migraine-free control patients (n=31) were compared with patients with migraine without aura who reported 1 to 4 migraine days in the previous 3 months (n=29). Additional inclusion criteria included an interictal photophobia score of 2 to 6 on a numeric rating scale with a range of 1 to 10, and an ictal photophobia score >4. Participants’ depression, anxiety, and stress levels were assessed with the 21-item version of the Depression Anxiety Stress Scale.

Compared with the control group, patients with migraine had higher levels of photophobia (P=.001), depressive symptoms, anxiety symptoms, and stress (all P <.001). In all participants, photophobia correlated positively with age (ρ = .318; P =.013) and scores for depression (ρ = .459; P <.001), anxiety (ρ = .346; P =.008), and stress (ρ = .368; P =.005).

“Considering higher levels of photophobia in depression and the comorbidity of migraine and depression, it might be possible that depression contributes to interictal photophobia in patients with migraine,” and anxiety and stress may have similar effects, according to the researchers. “Both are also related to migraine and their possible impact on photophobia in migraine may be explained by pupillary dysfunction,” they wrote.

For example, other studies have noted that individuals with anxiety disorders and posttraumatic stress disorder have exaggerated pupillary dilation in response to stressful stimuli, even after the clinically active phase of the disorder has ended. Further research with larger sample sizes are needed to elucidate the associations found in the present investigation.^6-8

Summary and Clinical Applicability

Photophobia correlated positively with depression, anxiety, and stress scores in both migraineurs and migraine-free controls.

References

1. Seidel S, Beisteiner R, Manecke M, Aslan TS, Wöber C. Psychiatric comorbidities and photophobia in patients with migraine. J Headache Pain.2017;18(1):18.
2. Giffin NJ, Ruggiero L, Lipton RB, et al. Premonitory symptoms in migraine: an electronic diary study. Neurology. 2003;60(6):935-940.
3. Main A, Dowson A, Gross M. Photophobia and phonophobia in migraineurs between attacks. Headache. 1997;37(8):492-495.
4. Risal A, Manandhar K, Holen A, Steiner TJ, Linde M. Comorbidities of psychiatric and headache disorders in Nepal: implications from a nationwide population-based study. J Headache Pain. 2016;17:45.
5. Llop S, Frandsen JE, Digre KB, et al. Increased prevalence of depression and anxiety in patients with migraine and interictal photophobia. J Headache Pain. 2016;17:34.
6. Bakes A, Bradshaw CM, Szabadi E. Attenuation of the pupillary light reflex in anxious patients. Br J Clin Pharmacol. 1990;30(3):377-381.
7. Kojima M, Shioiri T, Hosoki T, Kitamura H, Bando T, Someya T. Pupillary light reflex in panic disorder. A trial using audiovisual stimulation. Eur Arch Psychiatry Clin Neurosci. 2004;254(4):242-244.
8. Cascardi M, Armstrong D, Chung L, Paré D. Pupil response to threat in trauma-exposed individuals with or without PTSD. J Trauma Stress. 2015;28(4):370-374.