-
Frontiers in Neurology 2020Migraine is a common and disabling brain disorder with a broad and heterogeneous phenotype, involving both pain and painless symptoms. Over recent years, more clinical... (Review)
Review
Migraine is a common and disabling brain disorder with a broad and heterogeneous phenotype, involving both pain and painless symptoms. Over recent years, more clinical and research attention has been focused toward the premonitory phase of the migraine attack, which can start up to days before the onset of head pain. This early phase can involve symptomatology, such as cognitive and mood change, yawning, thirst and urinary frequency and sensory sensitivities, such as photophobia and phonophobia. In some patients, these symptoms can warn of an impending headache and therefore offer novel neurobiological insights and therapeutic potential. As well as characterization of the phenotype of this phase, recent studies have attempted to image this early phase using functional neuroimaging and tried to understand how the symptoms are mediated, how a migraine attack may be initiated, and how nociception may follow thereafter. This review will summarize the recent and evolving findings in this field and hypothesize a mechanism of subcortical and diencephalic brain activation during the start of the attack, including that of basal ganglia, hypothalamus, and thalamus prior to headache, which causes a top-down effect on brainstem structures involved in trigeminovascular nociception, leading ultimately to headache.
PubMed: 32269547
DOI: 10.3389/fneur.2020.00140 -
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 -
Animal Cognition Nov 2023Light provides a widely abundant energy source and valuable sensory cue in nature. Most animals exposed to light have photoreceptor cells and in addition to eyes, there... (Review)
Review
Light provides a widely abundant energy source and valuable sensory cue in nature. Most animals exposed to light have photoreceptor cells and in addition to eyes, there are many extraocular strategies for light sensing. Here, we review how these simpler forms of detecting light can mediate rapid behavioural responses in animals. Examples of these behaviours include photophobic (light avoidance) or scotophobic (shadow) responses, photokinesis, phototaxis and wavelength discrimination. We review the cells and response mechanisms in these forms of elementary light detection, focusing on aquatic invertebrates with some protist and terrestrial examples to illustrate the general principles. Light cues can be used very efficiently by these simple photosensitive systems to effectively guide animal behaviours without investment in complex and energetically expensive visual structures.
Topics: Animals; Photoreceptor Cells; Eye; Light
PubMed: 37650997
DOI: 10.1007/s10071-023-01818-6 -
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 -
Cureus Jun 2021Vestibular migraine (VM) is one of the most common types of episodic vertigo. Over the last 11 years, this disorder has been studied by both neurologists and... (Review)
Review
Vestibular migraine (VM) is one of the most common types of episodic vertigo. Over the last 11 years, this disorder has been studied by both neurologists and otolaryngologists. Based on the clinical symptoms and previous migraine history, the Barany Society and the International Classification of Headache Disorders have created the diagnostic criteria for VM. Unilateral and pulsatile headache, phonophobia, photophobia, auras, and a previous history of migraine have been included in these criteria. Although these symptoms are common and widely known, other symptoms not included in the Barany Society criteria are emerging and have been described in some clinical studies. These emerging criteria include audio-vestibular symptoms such as hearing loss, ear fullness, and tinnitus. Ringing ears could be associated with other vestibular disorders such as superior canal dehiscence and Ménière's disease, but not in VM. The frequency, pathophysiological contributors, and clinical characteristics of this symptom in individuals with VM will be explored in this review.
PubMed: 34336489
DOI: 10.7759/cureus.15998 -
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 -
Headache Apr 2015Photophobia is a debilitating feature of many headache disorders. (Review)
Review
BACKGROUND
Photophobia is a debilitating feature of many headache disorders.
OVERVIEW
Clinical and preclinical research has identified several potential pathways involved in enhanced light sensitivity. Some of these structures include trigeminal afferents in the eye, second-order neurons in the trigeminal nucleus caudalis, third-order neurons in the posterior thalamus, modulatory neurons in the hypothalamus, and fourth-order neurons in the visual and somatosensory cortices. It is unclear to what degree each site plays a role in establishing the different temporal patterns of photophobia across different disorders. Peptides such as calcitonin gene-related peptide and pituitary adenylate cyclase-activating polypeptide may play a role in photophobia at multiple levels of the visual and trigeminal pathways.
CONCLUSION
While our understanding of photophobia has greatly improved in the last decade, there are still unanswered questions. These answers will help us develop new therapies to provide relief to patients with primary headache disorders.
Topics: Headache Disorders, Primary; Humans; Photophobia; Trigeminal Nerve; Visual Pathways
PubMed: 25790126
DOI: 10.1111/head.12532 -
Frontiers in Neurology 2022To investigate the auditory features of patients with vestibular migraine (VM) and to analyze the possible relevant factors of hearing loss.
OBJECTIVES
To investigate the auditory features of patients with vestibular migraine (VM) and to analyze the possible relevant factors of hearing loss.
METHODS
A total of 166 patients with VM were enrolled. Demographic variables, age of onset, disease course, distribution of vestibular attacks, characteristics of hearing loss, and the coexistence of related disorders, such as visual aura, familial history, motion sickness, nausea, headache, photophobia, otalgia, tinnitus, aural fullness, and phonophobia, were analyzed and compared.
RESULTS
Patients with VM can manifest otalgia (8.4%), tinnitus (51.8%), aural fullness (41%), and phonophobia (31.9%). Of 166 patients, the prevalence of VMw was 21.1% ( = 35). Patients with VMw mainly manifested mild and easily reversible low-frequency hearing loss. The proportions of tinnitus and aural fullness were significantly larger in patients with VMw than that in patients with VMo ( < 0.05). The duration of vestibular symptoms was significantly shorter in patients with VMw ( < 0.05). However, the age of onset, disease course, gender, frequency of vestibular attacks, the coexistence of visual aura, familial history, motion sickness, nausea, headache, photophobia, otalgia, and phonophobia had no significant difference between the two groups.
CONCLUSION
Auditory symptoms were common in patients with VM. The hearing loss of VM was characterized by a mild and easily reversible low-frequency hearing loss, accompanied by higher proportions of tinnitus and aural fullness, and a shorter duration of vestibular symptoms compared with patients with VMo.
PubMed: 35911900
DOI: 10.3389/fneur.2022.944001