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Frontiers in Neurology 2022Calcitonin gene-related peptide (CGRP) plays a pivotal role in migraine physiology, not only regarding migraine pain but also associated symptoms such as photophobia....
BACKGROUND
Calcitonin gene-related peptide (CGRP) plays a pivotal role in migraine physiology, not only regarding migraine pain but also associated symptoms such as photophobia. The aim of the present study was to assess monoclonal antibodies targeting CGRP efficacy not only in terms of headache and migraine frequency and disability but also in reducing ictal photophobia.
MATERIAL AND METHODS
This is a retrospective observational study, conducted at the Headache Center-ASST Spedali Civili Brescia. All patients in monthly treatment with galcanezumab with at least a 6-month follow-up in September 2022 with reported severe photophobia during migraine attacks were included. Data regarding headache frequency, analgesics consumption, and migraine disability were collected quarterly. Moreover, patients were asked the following information regarding photophobia: (1) whether they noticed an improvement in photophobia during migraine attacks since galcanezumab introduction; (2) the degree of photophobia improvement (low, moderate, and high); and (3) timing photophobia improvement.
RESULTS
Forty-seven patients were enrolled in the present study as they met the inclusion criteria. Seventeen patients had a diagnosis of high-frequency episodic migraine and 30 of chronic migraine. From baseline to T3 and T6, a significant improvement in terms of headache days (19.2 ± 7.6 vs. 8.6 ± 6.8 vs. 7.7 ± 5.7; < 0.0001), migraine days (10.4 ± 6.7 vs. 2.9 ± 4.3 vs. 3.6 ± 2.8; < 0.0001), analgesics consumption (25.1 ± 28.2 vs. 7.6 ± 7.5 vs. 7.6 ± 8.1; < 0.0001), MIDAS score (82.1 ± 48.4 vs. 21.6 ± 17.6 vs. 18.1 ± 20.5; < 0.0001), and HIT-6 score (66.2 ± 6.2 vs. 57.2 ± 8.6 vs. 56.6 ± 7.6; < 0.0001) was found. Thirty-two patients (68.1%) reported a significant improvement in ictal photophobia, with over half of the patients reporting it within the first month of treatment. Photophobia improvement was more frequent in patients with episodic migraine ( = 0.02) and triptans responders ( = 0.03).
CONCLUSIONS
The present study confirms previous reports regarding galcanezumab efficacy beyond migraine frequency. In particular, over 60% of patients, in our cohort, documented a significant improvement also in reducing ictal photophobia. This improvement was, in most patients, moderate to high, and within the first 6 months of treatment, regardless of the clinical response on migraine frequency.
PubMed: 36742057
DOI: 10.3389/fneur.2022.1088036 -
International Journal of Molecular... Mar 2023Light is a fundamental aspect of our lives, being involved in the regulation of numerous processes in our body. While blue light has always existed in nature, with the... (Review)
Review
Light is a fundamental aspect of our lives, being involved in the regulation of numerous processes in our body. While blue light has always existed in nature, with the ever-growing number of electronic devices that make use of short wavelength (blue) light, the human retina has seen increased exposure to it. Because it is at the high-energy end of the visible spectrum, many authors have investigated the theoretical harmful effects that it poses to the human retina and, more recently, the human body, given the discovery and characterization of the intrinsically photosensitive retinal ganglion cells. Many approaches have been explored, with the focus shifting throughout the years from examining classic ophthalmological parameters, such as visual acuity, and contrast sensitivity to more complex ones seen on electrophysiological assays and optical coherence tomographies. The current study aims to gather the most recent relevant data, reveal encountered pitfalls, and suggest future directions for studies regarding local and/or systemic effects of blue light retinal exposures.
Topics: Humans; Light; Vision, Ocular; Retina; Retinal Ganglion Cells; Visual Acuity
PubMed: 36983068
DOI: 10.3390/ijms24065998 -
Neurologia Mar 2024Visual snow syndrome (VSS) is a central nervous system disorder that consists of the constant perception of small black and white dots throughout the entire visual field. (Review)
Review
INTRODUCTION
Visual snow syndrome (VSS) is a central nervous system disorder that consists of the constant perception of small black and white dots throughout the entire visual field.
DEVELOPMENT
VSS can present from infancy to old age, with greater prevalence in the young population, and shows no difference between sexes. The diagnostic criteria include the presence of visual snow and such other visual phenomena as palinopsia, photophobia, nyctalopia, and other persistent visual phenomena. The pathophysiology of VSS is unknown, but hyperexcitability of the visual cortex and a dysfunction in higher-order visual processing are postulated as potential mechanisms. The prevalence of migraine among patients with VSS is high, compared to the general population, and symptoms are more severe in patients presenting both conditions. No effective treatment is available, but the drug with the best results is lamotrigine, which is recommended only in selected cases with severe functional limitation.
CONCLUSIONS
VSS is a little-known and underdiagnosed entity, but the increasing number of studies in recent years has made it possible to establish diagnostic criteria and begin studying its pathophysiology. This entity is closely related to migraine, with overlapping symptoms and probably shared pathophysiological mechanisms.
Topics: Humans; Migraine with Aura; Vision Disorders; Migraine Disorders; Perceptual Disorders
PubMed: 37442427
DOI: 10.1016/j.nrleng.2021.05.012 -
Headache Sep 2023To examine whether sensory hypersensitivity contributes to headache-related disability in a secondary analysis of patients with post-traumatic headache.
OBJECTIVE
To examine whether sensory hypersensitivity contributes to headache-related disability in a secondary analysis of patients with post-traumatic headache.
BACKGROUND
Up to one-third of individuals with traumatic brain injuries report persistent headache 3 months post-injury. High rates of allodynia and photophobia have been observed in clinical studies and animal models of post-traumatic headache, but we do not fully understand how sensory amplifications impact post-traumatic headache-related disability.
METHODS
We identified a cross-sectional sample of patients from the American Registry for Migraine Research database with new or worsening headaches post-head injury from 2016 to 2020 and performed a secondary analysis of those data. We modeled the relationship between sensory sensitivity and Migraine Disability Assessment scores using questionnaires. Candidate variables included data collection features (study site and year), headache-related and general clinical features (headache frequency, migraine diagnosis, abuse history, sex, age, cognitive and affective symptom scores), and sensory symptoms (related to light, sound, and touch sensitivity).
RESULTS
The final sample included 193 patients (median age 46, IQR 22; 161/193, 83.4% female). Migraine Disability Assessment scores ranged from 0 to 260 (median 47, IQR 87). The final model included allodynia, hyperacusis, photosensitivity, headache days per month, abuse history, anxiety and depression, cognitive dysfunction, and age (R = 0.43). An increase of one point in allodynia score corresponded to a 3% increase in headache disability (95% CI: 0%-7%; p = 0.027), an increase of one-tenth of a point in the photosensitivity score corresponded to a 12% increase (95% CI: 3%-25%; p = 0.002), and an increase of one point in the hyperacusis score corresponded to a 2% increase (95% CI: 0%-4%; p = 0.016).
CONCLUSIONS
Increased photosensitivity, allodynia, and hyperacusis were associated with increased headache-related disability in this sample of patients with post-traumatic headache. Symptoms of sensory amplification likely contribute to post-traumatic headache-related disability and merit an ongoing investigation into their potential as disease markers and treatment targets.
Topics: Female; Animals; Male; Post-Traumatic Headache; Cross-Sectional Studies; Hyperacusis; Hyperalgesia; Headache; Migraine Disorders; Hypersensitivity
PubMed: 37638410
DOI: 10.1111/head.14604 -
Neurologia Sep 2021Visual snow syndrome (VSS) is a central nervous system disorder that consists of the constant perception of small black and white dots throughout the entire visual field. (Review)
Review
INTRODUCTION
Visual snow syndrome (VSS) is a central nervous system disorder that consists of the constant perception of small black and white dots throughout the entire visual field.
DEVELOPMENT
VSS can present from infancy to old age, with greater prevalence in the young population, and shows no difference between sexes. The diagnostic criteria include the presence of visual snow and such other visual phenomena as palinopsia, photophobia, nyctalopia, and other persistent visual phenomena. The pathophysiology of VSS is unknown, but hyperexcitability of the visual cortex and a dysfunction in higher-order visual processing are postulated as potential mechanisms. The prevalence of migraine among patients with VSS is high, compared to the general population, and symptoms are more severe in patients presenting both conditions. No effective treatment is available, but the drug with the best results is lamotrigine, which is recommended only in selected cases with severe functional limitation.
CONCLUSIONS
VSS is a little-known and underdiagnosed entity, but the increasing number of studies in recent years has made it possible to establish diagnostic criteria and begin studying its pathophysiology. This entity is closely related to migraine, with overlapping symptoms and probably shared pathophysiological mechanisms.
PubMed: 34521544
DOI: 10.1016/j.nrl.2021.05.012 -
Journal of Ophthalmic & Vision Research 2019To determine the prevalence of asthenopia and its associated factors in a sample of university students in Iran. (Review)
Review
PURPOSE
To determine the prevalence of asthenopia and its associated factors in a sample of university students in Iran.
METHODS
In this cross-sectional study, participants were selected using multistage cluster sampling. Presence of at least one of the 10 symptoms-foreign body sensation, diplopia, blurred vision, eye swelling, dry eye, eye pain, difficulty in sustaining visual operations, decreased visual acuity, tearing, and photophobia-was considered as asthenopia. Ocular examinations, including uncorrected/corrected visual acuity measurement, objective/subjective refraction, cover test, amplitude of accommodation (AA), and near point of convergence (NPC) were performed.
RESULTS
Of the 1,462 students (mean age: 22.8 3.1 years), 73% were women. The age- and gender-standardized prevalence was 70.9% (95% confidence interval [CI]: 68.3-73.5), 39.8% (95% CI: 36.4-43.1), and 19.7% (95% CI: 16.0-23.3) based on the presence of at least one, two, and three symptoms, respectively. The prevalence was significantly higher in females ( = 0.048), hyperopic students ( 0.001), and astigmatic participants ( 0.001). The mean AA and NPC were 9.7 2.6 D and 10.2 4.2 D ( = 0.008) and 7.0 2.1 cm and 7.7 3.9 cm ( 0.001) in participants with and without asthenopia, respectively. Multiple regression model revealed age (28-29 years), astigmatism, and NPC as independent associated factors (odds ratios: 3.51, 1.61, and 0.91, respectively).
CONCLUSION
This study shows relatively high prevalence of asthenopia in university students. Demographic factors and visual system disorders are important risk factors and timely correction of conditions may lead to decreased asthenopia.
PubMed: 31875103
DOI: 10.18502/jovr.v14i4.5455 -
Neuron Mar 2018Migraine is an extremely common but poorly understood nervous system disorder. We conceptualize migraine as a disorder of sensory network gain and plasticity, and we... (Review)
Review
Migraine is an extremely common but poorly understood nervous system disorder. We conceptualize migraine as a disorder of sensory network gain and plasticity, and we propose that this framing makes it amenable to the tools of current systems neuroscience.
Topics: Animals; Brain; Cortical Spreading Depression; Humans; Migraine Disorders; Nerve Net; Neuronal Plasticity; Neurosciences; Psychomotor Performance; Systems Analysis
PubMed: 29518355
DOI: 10.1016/j.neuron.2018.01.029 -
Frontiers in Neurology 2022Migraine is a highly prevalent neurological disease of varying attack frequency. Headache attacks that are accompanied by a combination of impact on daily activities,... (Review)
Review
Migraine is a highly prevalent neurological disease of varying attack frequency. Headache attacks that are accompanied by a combination of impact on daily activities, photophobia and/or nausea are most commonly migraine. The headache phase of a migraine attack has attracted more research, assessment tools and treatment goals than any other feature, characteristic, or phase of migraine. However, the migraine attack may encompass up to 4 phases: the prodrome, aura, headache phase and postdrome. There is growing recognition that the burden of migraine, including symptoms associated with the headache phase of the attack, may persist between migraine attacks, sometimes referred to as the "interictal phase." These include allodynia, hypersensitivity, photophobia, phonophobia, osmophobia, visual/vestibular disturbances and motion sickness. Subtle interictal clinical manifestations and a patient's trepidation to make plans or commitments due to the unpredictability of migraine attacks may contribute to poorer quality of life. However, there are only a few tools available to assess the interictal burden. Herein, we examine the recent advances in the recognition, description, and assessment of the interictal burden of migraine. We also highlight the value in patients feeling comfortable discussing the symptoms and overall burden of migraine when discussing migraine treatment needs with their provider.
PubMed: 36408525
DOI: 10.3389/fneur.2022.1032103 -
Frontiers in Neurology 2014Many adult outpatients with attention-deficit/hyperactivity disorder (ADHD) report an oversensitivity to light. We explored the link between ADHD and photophobia in an... (Review)
Review
Many adult outpatients with attention-deficit/hyperactivity disorder (ADHD) report an oversensitivity to light. We explored the link between ADHD and photophobia in an online survey (N = 494). Self-reported photophobia was prevalent in 69% of respondents with, and in 28% of respondents without, ADHD (symptoms). The ADHD (symptoms) group wore sunglasses longer during daytime in all seasons. Photophobia may be related to the functioning of the eyes, which mediate dopamine and melatonin production systems in the eye. In the brain, dopamine and melatonin are involved in both ADHD and circadian rhythm disturbances. Possibly, the regulation of the dopamine and melatonin systems in the eyes and in the brain are related. Despite the study's limitations, the results are encouraging for further study on the pathophysiology of ADHD, eye functioning, and circadian rhythm disturbances.
PubMed: 25540636
DOI: 10.3389/fneur.2014.00256 -
BMJ Case Reports Jul 2019
Topics: Adolescent; Anti-Bacterial Agents; Ceftriaxone; Coitus; Conjunctivitis, Bacterial; Gonorrhea; Humans; Levofloxacin; Male; Neisseria gonorrhoeae; Orbital Cellulitis; Photophobia; Treatment Outcome
PubMed: 31340941
DOI: 10.1136/bcr-2018-227787