“It’s extremely common for people to have light sensitivity and eye pain in migraine,” according to Deborah Friedman, MD, MPH, a neuro-ophthalmologist and professor and the chief of the division of headache medicine at UT Southwestern Medical Center in Dallas. “Light sensitivity, known as photophobia, occurs more frequently than many other migraine symptoms, including nausea, vomiting, sensitivity to sound, or sensitivity to odor. In terms of how many people experience it as a symptom, it’s second only to headache,” Dr. Friedman says. “Light sensitivity not only causes eye pain and aversion to light; it can make the headache worse,” she says.
2. What Causes Light Sensitivity in Migraine?
Light perception starts in the eye, says Friedman. “There are different kinds of cells that are located in the retina, which is the back surface on the inside of the eye, which help us perceive light and colors,” she says. A special kind of cells called intrinsically photosensitive retinal ganglion cells (ipRGCs) have receptors that express a compound called melanopsin, explains Friedman. The ipRGCs project light information to the hypothalamus, the part of the brain that regulates our sleep and wake cycle, she says. “The ganglion cells also project to a part of the brain called the thalamus, which is a part of the brain that senses pain. It’s thought that the projection to the thalamus is what causes the exposure to light to be painful during a migraine,” says Friedman.
3. When During a Migraine Attack Does Photophobia Typically Occur?
Light sensitivity can begin in a migraine attack even before the head pain starts, says Friedman. “I’ve had patients tell me that photophobia can be one of their very first symptoms of migraine. All of a sudden, light becomes too bright, and it starts to bother them. Many people notice that noise also becomes too loud — they start hearing things they wouldn’t normally be able to hear very well,” she says. Even if it doesn’t occur that early, the photophobia at least starts when the headache pain begins, says Friedman. “For most people the light sensitivity and eye pain persist for the duration of the headache, and some people even have residual photophobia after the head pain ends,” she says.
4. Can Bright Light Trigger a Migraine Attack?
It’s not uncommon for bright light or excessive light to bring on a migraine attack, says Friedman. “People will say that going out on a bright, sunny day or seeing the glare that’s reflected off snow or water can sometimes trigger their migraines,” she says. According to the National Headache Foundation, many types of light can trigger a migraine attack, including flickering or pulsing light (fluorescent light contains invisible pulsing, which is likely why it’s a common trigger), bright lights, computer screens, television, and movie screens. RELATED: The 11 Most Common Headache and Migraine Triggers and How to Deal With Them
5. Why Does Light Sensitivity Sometimes Become Chronic?
It’s not clear why light sensitivity can become chronic, says Friedman. “There are people who get light sensitivity with migraine, and eventually they’re just more light-sensitive all the time,” she says. “We do know that for people in the general population (not just people who have migraine), people with blue eyes or light-colored irises tend to be more light-sensitive,” she says. Although we don’t know the exact mechanism, it may be related to the reason people develop chronic migraine, she explains. “It seems to be caused by what we call central sensitization that occurs in the brain,” says Friedman. Central sensitization is a condition of the central nervous system that can occur in people with chronic pain conditions; the system that mediates the pain becomes sensitized and is in a persistent state of high reactivity. This lowers the threshold for what causes pain, which means it takes less and less of a stimulus to produce a response, explains Friedman. “That’s the same thing we see in the visual system. Over time, it takes less and less light to be bothersome; even with a dimmer or less bright light, some people will sometimes get the same response that they get when they have a migraine,” she says.
6. What’s the Best Treatment for Light Sensitivity and Eye Pain in Migraine?
“Unfortunately, there’s no magic pill that you can take that’s going to take your photophobia away. Most people who experience photophobia during a migraine attack go into a dark room,” says Friedman. Medications used to treat acute attacks often work to treat the photophobia, because the symptom is part of the migraine process, she adds. Acute medications can include nonsteroidal anti-inflammatory drugs (NSAIDs), triptans, gepants, and ditans. “The medication helps the headaches get better faster, and it helps with photophobia as well as other symptoms of migraine,” says Friedman. Preventive treatment of migraine may also help with chronic photophobia, according to the American Migraine Foundation.
7. What Else Can Help With Light Sensitivity?
Beyond working with your doctor to manage your migraine, there are a few tools and strategies you can use to help manage light sensitivity, says Friedman.
Sunglasses “It can be helpful to wear sunglasses, but not super-dark glasses,” she says. “We recommend an amber tint; other, darker tints can make it harder for the eyes to readjust when you aren’t wearing them.”FL-41 glasses These glasses have a rose-colored tint that blocks the blue wavelength of light, which seems to be the wavelength that is the most bothersome to people, explains Friedman. “You can buy these glasses on the internet, or if you have prescription glasses, you can get the lenses tinted,” she says. If FL-41 glasses don’t seem to help you, some people find that using glasses with a light yellow tint works for them while indoors, she adds.Anti-glare computer screens or filters These are used to reduce glare and reflections on your computer monitor, which can be helpful, especially if you use your computer a lot, says Friedman.Less screen time If possible, limit the amount of time that you spend looking at a screen, she suggests.Blue-light-blocking glasses Glasses marketed as blocking blue light can be helpful, though their efficacy varies from brand to brand, says Friedman. “It’s not clear to me what coating is used to block the blue light and whether it’s standard throughout the industry,” she adds. They may work for you, but you may need to try a few pairs to find the right glasses.Use a green light Studies show that using green light instead of incandescent light or fluorescent light can be very helpful, she says. “Green seems to be the least unpleasant wavelength of light; people with photophobia can often tolerate this better than they can tolerate anything else,” says Friedman.
8. What Are the Drawbacks to Staying Inside, in the Dark, Most of the Time?
If you stay in a really dark room for a long period and then try to walk out into the sun, it’s painful, says Friedman. “When you try to come out into the light, it just gets harder and harder to do that. It creates a situation where a person almost has to become a hermit, because they can’t stand any light,” she says. There has to be a balance between trying to cut down on some of the ambient light, particularly the blue wavelengths of light, and holing up in the dark, she adds.
9. How Can a Person With Migraine Become More Tolerant of Light?
Typically, for people who have been living in the dark, we’ll try to move them into the light gradually, says Friedman. “So we gradually lighten up the tint in their glasses if they’ve been using glasses and gradually turn up the lights,” she says. In addition to increasing light tolerance and utilizing tools to help minimize the negative impacts of light, it’s important to get migraine attacks under control, says Friedman.
10. Who Should You See for Photophobia Treatment?
“Photophobia isn’t easy to treat; it’s a problem that many neurologists and ophthalmologists don’t really feel comfortable treating. If your provider isn’t comfortable treating you, you might ask them to refer you to a neuro-ophthalmologist,” says Friedman.
11. When Should You Seek Out an Ophthalmologist?
You should get certain symptoms checked out by an eye specialist, Friedman says. “For example, if there’s a lot of discomfort with the eye that doesn’t just occur with exposure to light. Itching, burning, tearing, redness, foreign body sensation (when you feel like you have something in your eye), a change in the appearance of the eye, or trouble with vision are signs you should see a specialist,” says Friedman. If people are sensitive to light outside that isn’t associated with their migraine attacks, that would also be a reason to visit an ophthalmologist. “You want to make sure you don’t have dry eye or another retinal disease that can cause sensitivity to light,” she adds.
