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Current Pain and Headache Reports Feb 2022To review the literature on the clinical characteristics of the symptoms other than headache that occurs during a migraine attack in childhood and adolescence. (Review)
Review
PURPOSE OF REVIEW
To review the literature on the clinical characteristics of the symptoms other than headache that occurs during a migraine attack in childhood and adolescence.
RECENT FINDINGS
Premonitory symptoms (42-67%) and postdrome phase (82%) are frequent. The most frequent auras were visual. There was no association between age or sex and the occurrence of auras. Cranial autonomic symptoms are also frequent (40-70%) and are most often bilateral. Most studies suggest that age is not associated with the frequency of nausea, vomiting, photophobia, and phonophobia. Cephalic cutaneous allodynia (15-37%) and osmophobia (20-53%) are common symptoms in children with migraine. Osmophobia has low sensitivity and high specificity for the diagnosis of migraine and is associated with the severity of the migraine. Migraine is a complex disease, and although headache is its best-known symptom, other symptoms also occur frequently during migraine attacks in children and adolescents.
Topics: Adolescent; Child; Humans; Hyperacusis; Hyperalgesia; Migraine Disorders; Photophobia; Vomiting
PubMed: 35064917
DOI: 10.1007/s11916-022-01015-z -
Journal of Neurology Aug 2022Photophobia is present in multiple types of headache disorders. The coexistence of photophobia and headache suggested the potential reciprocal interactions between... (Review)
Review
Photophobia is present in multiple types of headache disorders. The coexistence of photophobia and headache suggested the potential reciprocal interactions between visual and pain pathways. In this review, we summarized the photophobic characteristics in different types of headache disorders in the context of the three diagnostic categories of headache disorders: (1) primary headaches: migraine, tension-type headache, and trigeminal autonomic cephalalgias; (2) secondary headaches: headaches attributed to traumatic brain injury, meningitis, non-traumatic subarachnoid hemorrhage and disorder of the eyes; (3) painful cranial neuropathies: trigeminal neuralgia and painful optic neuritis. We then discussed potential mechanisms for the coexistence of photophobia and headache. In conclusion, the characteristics of photophobia are different among these headache disorders. The coexistence of photophobia and headache is associated with the interactions between visual and pain pathway at retina, midbrain, thalamus, hypothalamus and visual cortex. The communication between these pathways may depend on calcitonin gene-related peptide and pituitary cyclase-activating polypeptide transmission. Moreover, cortical spreading depression, an upstream trigger of headache, also plays an important role in photophobia by increased nociceptive input to the thalamus.
Topics: Headache; Headache Disorders; Humans; Migraine Disorders; Pain; Photophobia
PubMed: 35322292
DOI: 10.1007/s00415-022-11080-4 -
Current Neurology and Neuroscience... Jul 2018To provide an updated overview of Photophobia with a particular focus on photophobia related to migraine. (Review)
Review
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. 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.
Topics: Animals; Brain Injuries, Traumatic; Calcitonin Gene-Related Peptide; Humans; Migraine Disorders; Photophobia; Retinal Ganglion Cells; Rod Opsins
PubMed: 30058044
DOI: 10.1007/s11910-018-0864-0 -
Translational Neurodegeneration 2017Photophobia is a common symptom seen in many neurologic disorders, however, its pathophysiology remains unclear. Even the term is ambiguous. In this paper, we review the... (Review)
Review
Photophobia is a common symptom seen in many neurologic disorders, however, its pathophysiology remains unclear. Even the term is ambiguous. In this paper, we review the epidemiology and clinical manifestations of photophobia in neurological disorders, including primary headache, blepharospasm, progressive supranuclear palsy, and traumatic brain injury, discuss the definition, etiology and pathogenesis, and summarize practical methods of diagnosis and treatment.
PubMed: 28932391
DOI: 10.1186/s40035-017-0095-3 -
Ophthalmology Feb 2020
Topics: Adult; Analgesics; Cornea; Drug Combinations; Eye Pain; Humans; Keratitis; Lighting; Lubricant Eye Drops; Male; Occupational Exposure; Photophobia; Radiation Injuries; Timolol; Ultraviolet Rays; Visual Acuity
PubMed: 31973836
DOI: 10.1016/j.ophtha.2019.10.027 -
Journal of Neuro-ophthalmology : the... Dec 2019Migraine is a common disabling neurological disorder where attacks have been recognized to consist of more than headache. The premonitory, headache, and postdromal... (Review)
Review
BACKGROUND
Migraine is a common disabling neurological disorder where attacks have been recognized to consist of more than headache. The premonitory, headache, and postdromal phases are the various phases of the migraine cycle, where aura can occur before, during, or after the onset of pain. Migraine is also associated with photosensitivity and cranial autonomic symptoms, which includes lacrimation, conjunctival injection, periorbital edema, ptosis, nasal congestion, and rhinorrhoea. This review will present the current understanding of migraine pathophysiology and the relationship to the observed symptoms.
EVIDENCE ACQUISITION
The literature was reviewed with specific focus on clinical, neurophysiological, functional imaging, and preclinical studies in migraine including the studies on the role of calcitonin gene-related peptide (CGRP) and pituitary adenylate cyclase activating polypeptide (PACAP).
RESULTS
The phases of the migraine cycle have been delineated by several studies. The observations of clinical symptoms help develop hypotheses of the key structures involved and the biochemical and neuronal pathways through which the effects are mediated. Preclinical studies and functional imaging studies have provided evidence for the role of multiple cortical areas, the diencephalon, especially the hypothalamus, and certain brainstem nuclei in the modulation of nociceptive processing, symptoms of the premonitory phase, aura, and photophobia. CGRP and PACAP have been found to be involved in nociceptive modulation and through exploration of CGRP mechanisms, new successful treatments have been developed.
CONCLUSIONS
Migraine is a complex neural disorder and is important to understand when seeing patients who present to neuro-ophthalmology, especially with the successful translation from preclinical and clinical research leading to successful advances in migraine management.
Topics: Calcitonin Gene-Related Peptide; Humans; Migraine Disorders; Photophobia; Pituitary Adenylate Cyclase-Activating Polypeptide
PubMed: 31714319
DOI: 10.1097/WNO.0000000000000875 -
Aging Dec 2021
Topics: Aging; Circadian Rhythm; Humans; Photophobia; Sleep
PubMed: 34962893
DOI: 10.18632/aging.203806 -
Cephalalgia : An International Journal... Nov 2019The clinical picture, but also neuroimaging findings, suggested the brainstem and midbrain structures as possible driving or generating structures in migraine. (Review)
Review
BACKGROUND
The clinical picture, but also neuroimaging findings, suggested the brainstem and midbrain structures as possible driving or generating structures in migraine.
FINDINGS
This has been intensely discussed in the last decades and the advent of modern imaging studies refined the involvement of rostral parts of the pons in acute migraine attacks, but more importantly suggested a predominant role of the hypothalamus and alterations in hypothalamic functional connectivity shortly before the beginning of migraine headaches. This was shown in the NO-triggered and also in the preictal stage of native human migraine attacks. Another headache type that is clinically even more suggestive of hypothalamic involvement is cluster headache, and indeed a structure in close proximity to the hypothalamus has been identified to play a crucial role in attack generation.
CONCLUSION
It is very likely that spontaneous oscillations of complex networks involving the hypothalamus, brainstem, and dopaminergic networks lead to changes in susceptibility thresholds that ultimately start but also terminate headache attacks. We will review clinical and neuroscience evidence that puts the hypothalamus in the center of scientific attention when attack generation is discussed.
Topics: Autonomic Nervous System; Brain Stem; Craving; Dopamine; Emotions; Endocrine System; Headache; Humans; Hypothalamus; Migraine Disorders; Nitric Oxide; Nociception; Pain Perception; Photophobia; Prodromal Symptoms
PubMed: 31466456
DOI: 10.1177/0333102419867280 -
Nursing Standard (Royal College of... Jan 2024Migraine is a common neurological disorder characterised by a severe, pulsating headache, sometimes accompanied with photophobia or phonophobia and nausea and/or...
Migraine is a common neurological disorder characterised by a severe, pulsating headache, sometimes accompanied with photophobia or phonophobia and nausea and/or vomiting. The symptoms of migraine can have a significant adverse effect on a person's ability to undertake normal activities. Nurses have an important role in assisting patients in identifying migraine triggers and in supporting them to manage the symptoms of migraines through lifestyle changes and pharmacological treatments. This article describes different types of migraines and some differential diagnoses and 'red flag' symptoms that could indicate a more serious condition. The author also discusses non-pharmacological and pharmacological management strategies and treatments.
Topics: Humans; Migraine Disorders; Nausea; Vomiting; Photophobia; Hyperacusis
PubMed: 37994154
DOI: 10.7748/ns.2023.e12059 -
Cephalalgia : An International Journal... Aug 2023Clinical trials on anti-calcitonin gene-related peptide monoclonal antibodies poorly investigated their impact on migraine accompanying symptoms.
BACKGROUND
Clinical trials on anti-calcitonin gene-related peptide monoclonal antibodies poorly investigated their impact on migraine accompanying symptoms.
OBJECTIVE
To evaluate the impact of basal accompanying symptoms on anti-CGRP monoclonal antibodies treatment response and their evolution after six months of treatment in migraine patients.
METHODS
Patients with migraine diagnosis seen in the Headache Clinic and treated with erenumab, galcanezumab or fremanezumab were prospectively recruited. They completed a daily eDiary which provided data on headache frequency and the following accompanying symptoms of each day: photophobia, phonophobia, nausea, dizziness, and aura. Patients were classified as responders or non-responders based on 50% or greater reduction in headache days per month at month 6 (≥50% response rate). Accompanying symptoms ratios based on headache days per month were assessed per patient at baseline and after three and six months. Comparisons for basal characteristics, basal accompanying symptoms ratios and their evolution after six months between responders and non-responders were performed.
RESULTS
One hundred and fifty-eight patients were included, 44% (69/158) showed ≥50% response rate after six months. A significant reduction in headache days per month in both groups was found at month 6 (-9.4 days/month in ≥50% response rate group; p < 0.001, -2.2 days/month in <50% response rate group; p = 0.004). Additionally, significant decreases in photophobia (-19.5%, p < 0.001), phonophobia (-12.1%, p = 0.010) and aura ratios (-25.1%, p = 0.008) were found in ≥50% response rate group. No statistically significant reductions were found in nausea and dizziness in any group since their reduction was correlated with the decrease in headache days per month. Higher photophobia ratios at baseline were predictive of an increased response between months 3 and 6 (Incidence Risk Ratio = 0.928, p = 0.040).
CONCLUSIONS
The days per month with photophobia, phonophobia and aura decreased at a higher rate than headache days per month after six months in the ≥50% response group. Higher photophobia ratios were associated with higher response rates between three and six months. It could indicate an involvement of peripheral CGRP in photophobia as well as a central modulation of migraine through these treatments which mainly act on the periphery.
Topics: Humans; Antibodies, Monoclonal; Dizziness; Headache; Hyperacusis; Migraine Disorders; Nausea; Photophobia; Treatment Outcome
PubMed: 37555331
DOI: 10.1177/03331024231177636