Migraine and Light: A Narrative Review

Ada R. Artemenko MD, PhD; Elena Filatova MD, PhD; Yulia D. Vorobyeva MD; Thien Phu Do MD; Messoud Ashina MD, PhD, DMSc, FEAN; Alexey B. Danilov MD, PhD

Disclosures

Headache. 2022;62(1):4-10. 

In This Article

Abstract and Introduction

Abstract

Objective: In this narrative review, we summarize clinical and experimental data on the effect of light in migraine and discuss future prospects.

Background: Effective nonpharmacological treatment of hypersensitivity to light in migraine is an unmet clinical need. Current management strategies primarily consist of seeking a dark room and avoiding light exposure. Advances in the past 2 decades have improved our understanding of the underlying pathophysiology of how migraine is influenced by light. This may provide promising avenues for novel approaches in clinical management.

Methods: We searched MEDLINE for articles published from database inception up to September 1, 2021. We used the search term "migraine" with the search terms "light," "photophobia," "treatment," "trigger," "circadian rhythm," "environment," and/or "pathophysiology."

Results: Light is commonly reported as a trigger factor of migraine attacks, however, early manifestation of photophobia and false attribution is likely the actual cause based on data deriving from retrospective, prospective, and experimental studies. The most common photophobia symptoms in migraine are exacerbation of headache by light and abnormal sensitivity to light with the underlying neural pathways likely being dependent on ongoing activity in the trigeminovascular system. Clinical studies and experimental models have identified mediators of photophobia and uncovered narrow wavebands of the light spectrum that may reduce pain intensity during a migraine attack. Consequently, novel devices have undergone exploratory clinical trials with promising results.

Conclusion: False attribution is likely the reason why light is commonly reported as a trigger factor of migraine attacks, and a prospective confirmation is required to prevent unnecessary avoidance. The observation that individuals with migraine are not equally photophobic to all wavebands of the light spectrum opens the potential for innovative pain management strategies. In this context, using human-centric lighting (also called integrative lighting) to mimic the natural daylight cycle and avoid harmful wavebands through modern technology may prove beneficial. Future research should identify direct and indirect consequences of light and other environmental factors in migraine to fill out knowledge gaps and enable evidence-based care strategies within institutions, work environments, and other settings.

Introduction

Migraine is a neurovascular disorder that directly affects more than one billion individuals worldwide.[1,2] The typical clinical presentation comprises recurrent attacks of headache that are moderate-to-severe intensity, unilaterally localized, and accompanied by nausea and hypersensitivity to light and sounds.[3] A key feature of migraine is that these attacks may be provoked by various triggers factors,[2,4,5] whereas light is consistently reported as a common provocation factor[6]—a severe limitation in modern society. However, false attribution and recall bias may play a large role in these reports and lead to unnecessary avoidance of light.[7] Advances in the past 2 decades have improved our understanding of the underlying pathophysiology of how migraine is influenced by illumination,[8] which has led to novel nonpharmacological approaches in clinical management.[9] In this narrative review, we discuss available evidence of light as a trigger factor. Second, we evaluate the progress that has been made in dissecting the pathophysiology of photophobia and how this has improved our understanding of migraine pathogenesis. Last, we contextualize these findings in optimizing patient care and integration in clinical practice. In particular, we discuss the potential of modern light technology to reduce the negative impact of light in migraine.

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