Commentary
COMMENTARY—Patients With Severe Light Aversion Need Support
Those of us who care for patients with migraine dread seeing patients who come to the office wearing dark sunglasses, even in a dimly lit...
Treating Light Sensitivity
Tinted lenses may help patients with migraine and photophobia. Good et al in 1991 published a study that included 20 children with migraine. Patients wore glasses with FL-41–tinted lenses (ie, a rose-colored tint) or blue-tinted lenses. Patients with FL-41–tinted lenses had reduced headache frequency at four months, whereas patients with blue-tinted lenses did not experience a sustained reduction in headache frequency.
Patients with photophobia should not keep themselves in the dark. “Every single person who comes in with three layers of sunglasses, you have to tell them that the more you stay in the dark, the worse this is going to get,” Dr. Digre said. “We have to … slowly peel off the sunglasses, lift up the shades, and start getting used to more light.”
Botulinum toxin, sympathetic nerve blocks, gabapentin, and melatonin have been used in people with photophobia. Importantly, physicians should treat any underlying psychiatric or neurologic condition, including migraine, that may be driving patients’ light sensitivity, Dr. Digre said.
—Jake Remaly
Suggested Reading
Delwig A, Logan AM, Copenhagen DR, Ahn AH. Light evokes melanopsin-dependent vocalization and neural activation associated with aversive experience in neonatal mice. PLoS One. 2012;7(9):e43787.
Good PA, Taylor RH, Mortimer MJ. The use of tinted glasses in childhood migraine. Headache. 1991;31(8):533-536.
Jones KA, Hatori M, Mure LS, et al. Small-molecule antagonists of melanopsin-mediated phototransduction. Nat Chem Biol. 2013;9(10):630-635.
Kinard KI, Smith AG, Singleton JR, et al. Chronic migraine is associated with reduced corneal nerve fiber density and symptoms of dry eye. Headache. 2015;55(4):543-549.
Koktekir BE, Celik G, Karalezli A, Kal A. Dry eyes and migraines: is there really a correlation? Cornea. 2012;31(12):1414-1416.
Llop SM, 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.
Noseda R, Kainz V, Jakubowski M, et al. A neural mechanism for exacerbation of headache by light. Nat Neurosci. 2010;13(2):239-245.
Pucker AD, Ng SM, Nichols JJ. Over the counter (OTC) artificial tear drops for dry eye syndrome. Cochrane Database Syst Rev. 2016 Feb 23;2:CD009729.