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Neurologia 2023Photophobia is a symptom of abnormal light intolerance without pain sensation that requires an anamnesis and an examination to diagnose an underlying etiology. (Review)
Review
INTRODUCTION
Photophobia is a symptom of abnormal light intolerance without pain sensation that requires an anamnesis and an examination to diagnose an underlying etiology.
BASIC PROCEDURE
This article focuses on 30 clinical cases with isolated intense photophobia and on the review of the literature.
OBJECTIVE
The purpose of this article is to establish diagnostic criteria for photophobia.
RESULTS
The etiology of photophobia appears to be at the level of the intrinsically photosensitive retinal ganglion cells known as melanopsin cells and at a neurochemical level mediated by calcitonin-related peptide and the pituitary activating peptide cyclase.
CONCLUSION
The treatment of photophobia could consist of monoclonal antibodies against calcitonin-related peptide and/or pituitary activating peptide cyclase.
Topics: Humans; Photophobia; Calcitonin; Migraine Disorders; Rod Opsins; Retinal Ganglion Cells
PubMed: 35842130
DOI: 10.1016/j.nrleng.2020.12.004 -
The Journal of Headache and Pain Aug 2023Given the similar presentation of migraine aura and acute ischemic stroke, advancing patient age might change the characteristics of migraine with aura (MA) and be...
AIM
Given the similar presentation of migraine aura and acute ischemic stroke, advancing patient age might change the characteristics of migraine with aura (MA) and be clinically important. Clinical data, however, are limited. Experimental studies indicate a decrease in the magnitude of cortical spreading depression (CSD), the pathophysiological correlate of migraine aura, with advancing age. Our study aimed to assess the influence of age on the clinical features of MA.
METHODS
Three hundred and forty-three patients were interviewed using a structured questionnaire. The questions covered the headache characteristics and symptom types including the characteristics of the C-criterion, as defined by the International Classification of Headache Disorders 3 Edition. The association of age with MA characteristics was assessed.
RESULTS
The median age was 29 (IQR 28-52) and 235 of the 343 patients were women (69%). Individual symptoms of the C-criterion such as gradual aura spreading over longer than 5 min (P < 0.001), two or more aura symptoms occurring in succession (P = 0.005), duration of at least one MA symptom for longer than 60 min (P = 0.004), and associated headache (P = 0.01) were more frequent in younger patients. The number of symptoms including the C-characteristics decreased with increasing age (P < 0.001). Patients with sensory (P < 0.001), motor (P = 0.004) and speech disturbance (P = 0.02) were younger, and older patients with headache had less photophobia (P = 0.04) and phonophobia (P = 0.03). Sensitivity analyses yielded similar results.
CONCLUSION
The frequency of typical characteristics of migraine aura and migraine headache including photophobia and phonophobia decreases with advancing patient age. This might have potentially difficult implications for the diagnosis of MA in the elderly.
Topics: Humans; Female; Aged; Adult; Male; Migraine with Aura; Ischemic Stroke; Hyperacusis; Photophobia; Migraine Disorders; Epilepsy; Headache
PubMed: 37528414
DOI: 10.1186/s10194-023-01642-w -
Journal of Neuro-ophthalmology : the... Sep 2022Although patients with abnormal light sensitivity may present to an ophthalmologist or optometrist for the evaluation of photophobia, there are no previous reviews of...
BACKGROUND
Although patients with abnormal light sensitivity may present to an ophthalmologist or optometrist for the evaluation of photophobia, there are no previous reviews of the most common causes of this symptom.
METHODS
We conducted a retrospective chart review of patients who presented to our eye center between 2001 and 2009 primarily for the evaluation of photophobia. We recorded demographics, ocular examination findings, and diagnoses of these patients.
RESULTS
Our population included 58 women and 53 men. The mean age at presentation to the clinic was 37 years (range 6 months-94 years). The most frequent cause of photophobia was migraine headache (53.7%), followed by dry eye syndrome (36.1), ocular trauma (8.2%), progressive supranuclear palsy (6.8%), and traumatic brain injury (4.1%). A significant proportion of patients (25.9%) left the clinic without a cause for their photophobia documented by the examining physician (11.7% of adults and 69.4% of children).
CONCLUSIONS
Photophobia affects patients of all ages, and many patients are left without a specific diagnosis, indicating a significant knowledge gap among ophthalmologists and optometrists evaluating these patients.
Topics: Adult; Brain Injuries, Traumatic; Child; Dry Eye Syndromes; Female; Humans; Infant; Male; Migraine Disorders; Photophobia; Retrospective Studies
PubMed: 35427241
DOI: 10.1097/WNO.0000000000001556 -
The Journal of Headache and Pain Oct 2022Cardiac cephalalgia is an unusual condition that occurs during an episode of myocardial ischemia. Information about cardiac cephalalgia is scarce and its characteristics... (Review)
Review
BACKGROUND
Cardiac cephalalgia is an unusual condition that occurs during an episode of myocardial ischemia. Information about cardiac cephalalgia is scarce and its characteristics and physiopathology remain unclear. Our aim is to provide a narrative review of clinical characteristics and physiopathology of cardiac cephalalgia and to evaluate the current diagnostic criteria. METHODS: A search through PubMed was undertaken for studies on cardiac cephalalgia published until 20 September 2022. We summarized the literature and provide a comprehensive review of the headache characteristics and possible mechanisms. We also evaluated current International Classification of Headache Disorders third edition diagnostic criteria based on prior reported cases. RESULTS: In total, 88 cases were found. Headache characteristics were variable. Occipital location and throbbing pain were the most frequently reported. Headache was accompanied in most cases by cardiac symptoms. Criterion B was fulfilled by 98% of cases, criterion C1 by 72%, and criteria C2a and C2b by 37 and 93.2%, respectively. Regarding headache features described in diagnostic criterion C3, 'moderate to severe intensity', 'accompanied by nausea', 'not accompanied by photophobia or phonophobia' and 'aggravated by exertion', were reported in 75, 31, 55 and 55% of cases, respectively.
CONCLUSION
Cardiac cephalalgia characteristics are variable and the headache features described in the diagnostic criterion C3 might not be adequate. Given that cardiac cephalalgia can be the manifestation of a life-threatening condition it is important to increase the knowledge about this entity.
Topics: Humans; Headache; Headache Disorders; Myocardial Ischemia; Photophobia; Pain
PubMed: 36266636
DOI: 10.1186/s10194-022-01508-7 -
The New England Journal of Medicine Jul 2018
Topics: AIDS-Related Opportunistic Infections; Adult; Cerebrospinal Fluid; Cryptococcosis; Cryptococcus neoformans; HIV Seropositivity; Headache; Humans; Male; Meningoencephalitis; Photophobia
PubMed: 30021095
DOI: 10.1056/NEJMicm1801051 -
Current Neurology and Neuroscience... Jul 2018This review investigates the relationship between sensory sensitivity and traumatic brain injury (TBI), and the role sensory sensitivity plays in chronic disability. (Review)
Review
PURPOSE OF REVIEW
This review investigates the relationship between sensory sensitivity and traumatic brain injury (TBI), and the role sensory sensitivity plays in chronic disability.
RECENT FINDINGS
TBI is a significant cause of disability with a range of physical, cognitive, and mental health consequences. Sensory sensitivities (e.g., noise and light) are among the most frequently reported, yet least outwardly recognizable symptoms following TBI. Clinicians and scientists alike have yet to identify consistent nomenclature for defining noise and light sensitivity, making it difficult to accurately and reliably assess their influence. Noise and light sensitivity can profoundly affect critical aspects of independent function including communication, productivity, socialization, cognition, sleep, and mental health. Research examining the prevalence of sensory sensitivity and evidence for the association of sensory sensitivity with TBI is inconclusive. Evidence-based interventions for sensory sensitivity, particularly following TBI, are lacking.
Topics: Brain Injuries, Traumatic; Brain Injury, Chronic; Chronic Disease; Disabled Persons; Humans; Photophobia; Prevalence; Sensation Disorders
PubMed: 30008147
DOI: 10.1007/s11910-018-0867-x -
The Journal of Headache and Pain 2016Chronic migraine is a disabling, under-recognized, and undertreated disorder that increases health burdens. The aim of this study was to evaluate phenotypic features and...
BACKGROUND
Chronic migraine is a disabling, under-recognized, and undertreated disorder that increases health burdens. The aim of this study was to evaluate phenotypic features and the relevance of accompanying symptoms of migraine attacks in chronic migraine.
METHOD
This study was conducted as part of an ongoing Turkish Headache Database Study investigating the clinical characteristics and outcomes of headache syndromes in the Turkish population. The electronic database was examined retrospectively, and 835 patients with chronic migraine were included.
RESULTS
Patient group consisted of 710 women and 125 men (85 and 15 %, respectively). Mean patient age was 36.8 ± 13.5 years, median value of migraine onset was 60 months (18-120), median headache frequency was 25 days per month (16-30), median of attack duration was 12 h (4-24), and median of intensity was eight (7-9). Increasing headache days per month were inversely related with the presence of nausea, vomiting, phonophobia, and photophobia. Longer duration of headache (months) and higher visual analog scale (VAS) for headache intensity were associated with all accompanying symptoms. Phonophobia, nausea, photophobia, and vomiting were the most frequent accompanying symptoms (experienced by 80.2, 77.6, 71.2, and 40.9 % of patients, respectively). Osmophobia was also frequent in chronic migraine patients (53.4 %) and was closely associated with other accompanying symptoms. Vertigo and dizziness were observed less frequently, and they were not associated with accompanying symptoms.
CONCLUSION
Phenotype of chronic migraine may be associated with the course of chronification. Duration of illness and attack intensity were closely related with the presence of accompanying symptoms, although headache frequency was found to be inversely related to the presence of accompanying symptoms. Osmophobia was also a frequent symptom and was closely related with other accompanied symptoms, unlike vertigo and dizziness. Inclusion of osmophobia into the diagnostic criteria might improve accurate diagnosis of chronic migraine.
Topics: Adult; Databases, Factual; Female; Humans; Hyperacusis; Male; Middle Aged; Migraine Disorders; Nausea; Phenotype; Photophobia; Retrospective Studies; Symptom Assessment; Time Factors; Vomiting; Young Adult
PubMed: 26975363
DOI: 10.1186/s10194-016-0616-y -
F1000Research 2019Migraine is a common headache disorder characterized by often-severe headaches that may be preceded or accompanied by a variety of visual symptoms. Although a typical... (Review)
Review
Migraine is a common headache disorder characterized by often-severe headaches that may be preceded or accompanied by a variety of visual symptoms. Although a typical migraine aura is not difficult to diagnose, patients with migraine may report several other visual symptoms, such as prolonged or otherwise atypical auras, "visual blurring", "retinal migraine", "ophthalmoplegic migraine", photophobia, palinopsia, and "visual snow". Here, we provide a short overview of these symptoms and what is known about the relationship with migraine pathophysiology. For some symptoms, the association with migraine is still debated; for other symptoms, recent studies indicate that migraine mechanisms play a role.
Topics: Cognition; Humans; Migraine Disorders; Migraine with Aura; Vision Disorders
PubMed: 31448081
DOI: 10.12688/f1000research.18768.1 -
Acta Ophthalmologica May 2022The aim of the present study was to investigate photophobia and disability glare in adult patients with Marfan syndrome (MFS).
PURPOSE
The aim of the present study was to investigate photophobia and disability glare in adult patients with Marfan syndrome (MFS).
METHODS
In this case-control study, 44 patients with MFS (87 eyes) were compared to 44 controls (88 eyes), who were matched for age and sex. The subjects were asked to grade their photophobia and glare using 10-cm visual analogue scales (VAS), which were marked with 'never' at zero and 'always' at 10 -cm. In addition, disability glare was measured with C-Quant straylight meter.
RESULTS
The patients with MFS had significantly higher VAS scores than the controls in four out of seven statements related to photophobia and glare. When including cataract, spherical equivalent, iris colour, axial length and corneal curvature, three of the seven statements were still significantly different between the two groups. The mean straylight values were 1.29 ± 0.03 log(s) in the MFS group and 1.01 ± 0.03 log(s) in the control group (p < 0.001, mixed model). These differences remained significant after adjusting for cataract, spherical equivalent, iris colour, axial length and corneal curvature.
CONCLUSION
Patients with MFS reported more photophobia and had a higher straylight value than the control group. Awareness of these findings of more photophobia and glare in the MFS patients is important when counselling and treating these patients.
Topics: Adult; Case-Control Studies; Cataract; Glare; Humans; Light; Marfan Syndrome; Photophobia; Scattering, Radiation; Visual Acuity
PubMed: 34173343
DOI: 10.1111/aos.14935 -
Histology and Histopathology Dec 2019Melanopsin-expressing retinal ganglion cells (mRGCs) constitute a system in the mammalian retina used for irradiance detection, regulating non-image forming functions,... (Review)
Review
Melanopsin-expressing retinal ganglion cells (mRGCs) constitute a system in the mammalian retina used for irradiance detection, regulating non-image forming functions, such as photoentrainment of circadian rhythms, control of the pupillary light reflex, masking response, light-regulated melatonin secretion, and modulation of the sleep/wake cycle. There are five subtypes of mRGCs differentiated by morphology and function. Recent years of research on mRGCs have identified a broad number of neurodegenerative diseases in the eye and the brain with altered physiologic light responses, leading to disturbances of non-image forming light response(s). In this review, we briefly summarise the melanopsin system in the normal retina and discuss its role in connection to human aging (sleep/wake problems) and retinal pathology in Alzheimer and Parkinson diseases, diabetic retinopathy, mitochondrial optic neuropathies, glaucoma, retinitis pigmentosa, and in photophobia during migraine and in seasonal affective disorder (SAD). Finally, we discuss the diagnostic tools that are being used to differentiate retinal diseases involving the melanopsin system in the rods and cones from the inner versus the outer retina.
Topics: Aged; Aging; Alzheimer Disease; Animals; Circadian Rhythm; Diabetic Retinopathy; Glaucoma; Humans; Light; Macular Degeneration; Mice; Migraine Disorders; Parkinson Disease; Photophobia; Retina; Retinal Diseases; Retinal Ganglion Cells; Retinitis Pigmentosa; Rod Opsins; Seasonal Affective Disorder
PubMed: 31219170
DOI: 10.14670/HH-18-138