Top

The Journal of Headache and Pain

Published in:

Open Access 01-12-2024 | Migraine | Research

Photophobia is associated with lower sleep quality in individuals with migraine: results from the American Registry for Migraine Research (ARMR)

Authors: Nina Sharp, Mark J Burish, Kathleen B Digre, Jessica Ailani, Mahya Fani, Sophia Lamp, Todd J. Schwedt

Published in: The Journal of Headache and Pain | Issue 1/2024

Abstract

Background

Patients with migraine often have poor sleep quality between and during migraine attacks. Furthermore, extensive research has identified photophobia as the most common and most bothersome symptom in individuals with migraine, second only to headache. Seeking the comfort of darkness is a common strategy for managing pain during an attack and preventing its recurrence between episodes. Given the well-established effects of daily light exposure on circadian activity rhythms and sleep quality, this study aimed to investigate the relationship between photophobia symptoms and sleep quality in a cohort of patients with migraine.

Methods

A cross-sectional observational study was conducted using existing data extracted from the American Registry for Migraine Research (ARMR). Participants with a migraine diagnosis who had completed the baseline questionnaires (Photosensitivity Assessment Questionnaire (PAQ), Generalized Anxiety Disorder-7 (GAD-7), Patient Health Questionnaire-2 (PHQ-2)), and selected questions of the ARMR Sleep questionnaire were included. Models were created to describe the relationship of photophobia and photophilia with various sleep facets, including sleep quality (SQ), sleep disturbance (SDis), sleep onset latency (SOL), sleep-related impairments (SRI), and insomnia. Each model was controlled for age, sex, headache frequency, anxiety, and depression.

Results

A total of 852 patients meeting the inclusion criteria were included in the analysis (mean age (SD) = 49.8 (13.9), 86.6% (n = 738) female). Those with photophobia exhibited significantly poorer sleep quality compared to patients without photophobia (p < 0.001). Photophobia scores were associated with SQ (p < 0.001), SDis (p < 0.001), SOL (p = 0.011), SRI (p = 0.020), and insomnia (p = 0.005) after controlling for age, sex, headache frequency, depression, and anxiety, signifying that higher levels of photophobia were associated with worse sleep-related outcomes. Conversely, photophilia scores were associated with better sleep-related outcomes for SQ (p < 0.007), SOL (p = 0.010), and insomnia (p = 0.014).

Conclusion

Results suggest that photophobia is a significant predictor of poor sleep quality and sleep disturbances in migraine. These results underscore the necessity for comprehensive and systematic investigations into the intricate interplay between photophobia and sleep to enhance our understanding and develop tailored solutions for individuals with migraine.

Ashina M, Terwindt GM, Al-Karagholi MA-M et al (2021) Migraine: disease characterisation, biomarkers, and precision medicine. Lancet 397:1496–1504. https://doi.org/10.1016/S0140-6736(20)32162-0CrossRefPubMed

Lipton RB, Fanning KM, Buse DC et al (2018) Identifying natural subgroups of Migraine based on Comorbidity and Concomitant Condition profiles: results of the chronic migraine epidemiology and outcomes (CaMEO) study. Headache J Head Face Pain 58:933–947. https://doi.org/10.1111/head.13342CrossRef

Silberstein SD (1995) Migraine symptoms: results of a survey of self-reported migraineurs. Headache J Head Face Pain 35:387–396. https://doi.org/10.1111/j.1526-4610.1995.hed3507387.xCrossRef

Mulleners WM, Aurora SK, Chronicle EP et al (2001) Self-reported Photophobic Symptoms in Migraineurs and Controls Are Reliable and Predict Diagnostic Category Accurately. Headache J Head Face Pain 41:31–39. https://doi.org/10.1046/j.1526-4610.2001.111006031.x

Lipton RB, Croop R, Stock EG et al (2019) Rimegepant, an oral calcitonin gene–related peptide receptor antagonist, for Migraine. N Engl J Med 381:142–149. https://doi.org/10.1056/NEJMoa1811090CrossRefPubMed

Dodick DW, Lipton RB, Ailani J et al (2020) Ubrogepant, an Acute Treatment for Migraine, Improved patient-reported functional disability and satisfaction in 2 single-attack phase 3 Randomized trials, ACHIEVE I and II. Headache J Head Face Pain 60:686–700. https://doi.org/10.1111/head.13766CrossRef

Schwedt TJ, Digre K, Tepper SJ et al (2020) The American Registry for Migraine Research: Research methods and Baseline Data for an initial patient cohort. Headache J Head Face Pain 60:337–347. https://doi.org/10.1111/head.13688CrossRef

Munjal S, Singh P, Reed ML et al (2020) Most bothersome symptom in persons with migraine: results from the Migraine in America symptoms and treatment (MAST) study. Headache J Head Face Pain 60:416–429. https://doi.org/10.1111/head.13708CrossRef

Pearl TA, Dumkrieger G, Chong CD et al (2020) Sensory hypersensitivity symptoms in Migraine with vs without aura: results from the American Registry for Migraine Research. Headache J Head Face Pain 60:506–514. https://doi.org/10.1111/head.13745CrossRef

10.

Leibovit-Reiben Z, Dumkrieger G, Dodick DW et al (2022) Photophobia contributes to Migraine-Associated disability and reduced Work Productivity: results from the American Registry for Migraine Research (ARMR). J Neuroophthalmol. https://doi.org/10.1097/WNO.0000000000001967CrossRef

11.

Vgontzas A, Pavlović JM (2018) Sleep disorders and Migraine: review of literature and potential pathophysiology mechanisms. Headache J Head Face Pain 58:1030–1039. https://doi.org/10.1111/head.13358CrossRef

12.

Barbanti P, Fabbrini G, Aurilia C et al (2007) A case-control study on excessive daytime sleepiness in episodic migraine. Cephalalgia 27:1115–1119. https://doi.org/10.1111/j.1468-2982.2007.01399.xCrossRefPubMed

13.

Budhiraja R, Roth T, Hudgel DW et al (2011) Prevalence and Polysomnographic correlates of Insomnia Comorbid with Medical disorders. Sleep 34:859–867. https://doi.org/10.5665/SLEEP.1114CrossRefPubMedPubMedCentral

14.

Zhu Z, Fan X, Li X et al (2013) Prevalence and predictive factors for poor sleep quality among migraineurs in a tertiary hospital headache clinic. Acta Neurol Belg 113:229–235. https://doi.org/10.1007/s13760-012-0159-1CrossRefPubMed

15.

Kelman L, Rains JC (2005) Headache and sleep: examination of sleep patterns and complaints in a large clinical sample of migraineurs. Headache J Head Face Pain 45:904–910. https://doi.org/10.1111/j.1526-4610.2005.05159.xCrossRef

16.

Bruni O, Russo P, Violani C, Guidetti V (2004) Sleep and migraine: an Actigraphic Study. Cephalalgia 24:134–139. https://doi.org/10.1111/j.1468-2982.2004.00657.xCrossRefPubMed

17.

Martin LF, Patwardhan AM, Jain SV et al (2021) Evaluation of green light exposure on headache frequency and quality of life in migraine patients: a preliminary one-way cross-over clinical trial. Cephalalgia 41:135–147. https://doi.org/10.1177/0333102420956711CrossRefPubMed

18.

Lipton RB, Melo-Carrillo A, Severs M et al (2023) Narrow band green light effects on headache, photophobia, sleep, and anxiety among migraine patients: an open-label study conducted online using daily headache diary. Front Neurol 14

19.

Golombek DA, Rosenstein RE (2010) Physiology of Circadian Entrainment. Physiol Rev 90:1063–1102. https://doi.org/10.1152/physrev.00009.2009CrossRefPubMed

20.

Brennan KC, Bates EA, Shapiro RE et al (2013) Casein kinase Iδ mutations in familial migraine and Advanced Sleep Phase. Sci Transl Med 5:183ra56–183ra56. https://doi.org/10.1126/scitranslmed.3005784CrossRefPubMedPubMedCentral

21.

Benkli B, Kim SY, Koike N et al (2023) Circadian features of Cluster Headache and Migraine. Neurology 100:e2224–e2236. https://doi.org/10.1212/WNL.0000000000207240CrossRefPubMed

22.

Lee W, Min IK, Yang KI et al (2021) Classifying migraine subtypes and their characteristics by latent class analysis using data of a nation-wide population-based study. Sci Rep 11:21595. https://doi.org/10.1038/s41598-021-01107-7CrossRefPubMedPubMedCentral

23.

Llop SM, Frandsen JE, Digre KB et al (2016) Increased prevalence of depression and anxiety in patients with migraine and interictal photophobia. J Headache Pain 17:34. https://doi.org/10.1186/s10194-016-0629-6CrossRefPubMedPubMedCentral

24.

Malone C, Wachholtz A, Bhowmick A (2015) Migraine: treatments, comorbidities, and quality of life, in the USA. J Pain Res 537. https://doi.org/10.2147/JPR.S88207

25.

Photosensitivity in panic disorder - Bossini – 2009 - Depression and Anxiety - Wiley Online Library. https://onlinelibrary.wiley.com/doi/10.1002/da.20477. Accessed 6 Dec 2023

26.

Wu Y, Hallett M (2017) Photophobia in neurologic disorders. Transl Neurodegener 6:26. https://doi.org/10.1186/s40035-017-0095-3CrossRefPubMedPubMedCentral

27.

Cortese A, Conte A, Ferrazzano G et al (2018) Photophobia in multiple sclerosis. Mult Scler Relat Disord 26:55–57. https://doi.org/10.1016/j.msard.2018.09.005CrossRefPubMed

28.

Buysse DJ, Reynolds CF, Monk TH et al (1989) The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res 28:193–213. https://doi.org/10.1016/0165-1781(89)90047-4CrossRefPubMed

29.

Beck SL, Schwartz AL, Towsley G et al (2004) Psychometric evaluation of the Pittsburgh Sleep Quality Index in cancer patients. J Pain Symptom Manage 27:140–148. https://doi.org/10.1016/j.jpainsymman.2003.12.002CrossRefPubMed

30.

Osorio CD, Gallinaro AL, Lorenzi-Filho G, Lage LV (2006) Sleep quality in patients with fibromyalgia using the Pittsburgh Sleep Quality Index. J Rheumatol 33:1863–1865PubMed

31.

Beaudreau SA, Spira AP, Stewart A et al (2012) Validation of the Pittsburgh Sleep Quality Index and the Epworth Sleepiness Scale in older black and white women. Sleep Med 13:36–42. https://doi.org/10.1016/j.sleep.2011.04.005CrossRefPubMed

32.

Buysse DJ, Yu L, Moul DE et al (2010) Development and validation of patient-reported outcome measures for Sleep disturbance and sleep-related impairments. Sleep 33:781–792. https://doi.org/10.1093/sleep/33.6.781CrossRefPubMedPubMedCentral

33.

van Kooten JAMC, Terwee CB, Luijten MAJ et al (2021) Psychometric properties of the patient-reported outcomes Measurement Information System (PROMIS) Sleep disturbance and sleep-related impairment item banks in adolescents. J Sleep Res 30:e13029. https://doi.org/10.1111/jsr.13029CrossRefPubMed

34.

Lei Dk, Yousaf M, Janmohamed Sr et al (2020) Validation of patient-reported outcomes Information System Sleep disturbance and sleep-related impairment in adults with atopic dermatitis*. Br J Dermatol 183:875–882. https://doi.org/10.1111/bjd.18920CrossRefPubMed

35.

Spitzer RL, Kroenke K, Williams JBW, Löwe B (2006) A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med 166:1092–1097. https://doi.org/10.1001/archinte.166.10.1092CrossRefPubMed

36.

Sapra A, Bhandari P, Sharma S et al (2020) Using generalized anxiety Disorder-2 (GAD-2) and GAD-7 in a primary care setting. https://doi.org/10.7759/cureus.8224. Cureus 12:

37.

Kroenke K, Spitzer RL, Williams JBW (2003) The Patient Health Questionnaire-2: validity of a two-item depression screener. Med Care 41:1284–1292. https://doi.org/10.1097/01.MLR.0000093487.78664.3CCrossRefPubMed

38.

Seo J-G, Park S-P (2015) Validation of the Patient Health Questionnaire-9 (PHQ-9) and PHQ-2 in patients with migraine. J Headache Pain 16:65. https://doi.org/10.1186/s10194-015-0552-2CrossRefPubMedPubMedCentral

39.

Oh C-M, Kim HY, Na HK et al (2019) The effect of anxiety and depression on Sleep Quality of individuals with high risk for Insomnia: a Population-based study. Front Neurol 10

40.

Afonso P, Fonseca M, Teodoro T (2022) Evaluation of anxiety, depression and sleep quality in full-time teleworkers. J Public Health 44:797–804. https://doi.org/10.1093/pubmed/fdab164CrossRef

41.

Adams SK, Kisler TS (2013) Sleep quality as a mediator between Technology-Related Sleep Quality, Depression, and anxiety. Cyberpsychology Behav Soc Netw 16:25–30. https://doi.org/10.1089/cyber.2012.0157CrossRef

42.

Mehboudi A, Modanloo M, Shariati A et al (2016) Relationship between anxiety and sleep quality in patients on Hemodialysis in Borazjan City, 2014. J Res Dev Nurs Midwifery 12:56–63

43.

Ramsawh HJ, Stein MB, Belik S-L et al (2009) Relationship of anxiety disorders, sleep quality, and functional impairment in a community sample. J Psychiatr Res 43:926–933. https://doi.org/10.1016/j.jpsychires.2009.01.009CrossRefPubMed

44.

Seidel S, Beisteiner R, Manecke M et al (2017) Psychiatric comorbidities and photophobia in patients with migraine. J Headache Pain 18:18. https://doi.org/10.1186/s10194-017-0718-1CrossRefPubMedPubMedCentral

45.

Hayes AF (2017) Introduction to mediation, moderation, and conditional process analysis: A regression-based approach, Third Edition. Guilford publications

46.

Garrigós-Pedrón M, Segura-Ortí E, Gracia-Naya M, La Touche R (2022) Predictive factors of sleep quality in patients with chronic migraine. Neurol Engl Ed 37:101–109. https://doi.org/10.1016/j.nrleng.2018.11.009CrossRef

47.

Figueiro M, Nagare R, Price L (2018) Non-visual effects of light: how to use light to promote circadian entrainment and elicit alertness. Light Res Technol 50:38–62. https://doi.org/10.1177/1477153517721598CrossRefPubMed

48.

Rea M, Figueiro M (2018) Light as a circadian stimulus for architectural lighting. Light Res Technol 50:497–510. https://doi.org/10.1177/1477153516682368CrossRef

49.

Shishegar N, Boubekri M, Stine-Morrow EAL, Rogers WA (2021) Tuning environmental lighting improves objective and subjective sleep quality in older adults. Build Environ 204:108096. https://doi.org/10.1016/j.buildenv.2021.108096CrossRef

50.

Mason IC, Grimaldi D, Reid KJ et al (2022) Light exposure during sleep impairs cardiometabolic function. Proc Natl Acad Sci 119:e2113290119. https://doi.org/10.1073/pnas.2113290119CrossRefPubMedPubMedCentral

51.

Siraji MA, Spitschan M, Kalavally V, Haque S (2023) Light exposure behaviors predict mood, memory and sleep quality. Sci Rep 13:12425. https://doi.org/10.1038/s41598-023-39636-yCrossRefPubMedPubMedCentral

52.

Khanie MS, Illum T, Hosseinpour N et al (2023) Exploring the effects of spectral light exposure on University students’ sleep quality: a cross-sectional study. E3S Web Conf 396:01106. https://doi.org/10.1051/e3sconf/202339601106CrossRef

53.

Figueiro MG, Steverson B, Heerwagen J et al (2017) The impact of daytime light exposures on sleep and mood in office workers. Sleep Health 3:204–215. https://doi.org/10.1016/j.sleh.2017.03.005CrossRefPubMed

54.

Melanson EL, Ritchie HK, Dear TB et al (2018) Daytime bright light exposure, metabolism, and individual differences in wake and sleep energy expenditure during circadian entrainment and misalignment. Neurobiol Sleep Circadian Rhythms 4:49–56. https://doi.org/10.1016/j.nbscr.2017.12.002CrossRefPubMed

55.

Kawasaki A, Udry M, El Wardani M, Münch M (2021) Can Extra Daytime light exposure Improve Well-Being and Sleep? A pilot study of patients with Glaucoma. Front Neurol 11

56.

Dunster GP, Hua I, Grahe A et al (2023) Daytime light exposure is a strong predictor of seasonal variation in sleep and circadian timing of university students. J Pineal Res 74:e12843. https://doi.org/10.1111/jpi.12843CrossRefPubMed

57.

Wahl S, Engelhardt M, Schaupp P et al (2019) The inner clock—blue light sets the human rhythm. J Biophotonics 12:e201900102. https://doi.org/10.1002/jbio.201900102CrossRefPubMedPubMedCentral

58.

Bailes HJ, Lucas RJ (2013) Human melanopsin forms a pigment maximally sensitive to blue light (λmax ≈ 479 nm) supporting activation of G(q/11) and G(i/o) signalling cascades. Proc Biol Sci 280:20122987. https://doi.org/10.1098/rspb.2012.2987CrossRefPubMedPubMedCentral

59.

Lockley SW, Brainard GC, Czeisler CA (2003) High sensitivity of the human circadian melatonin rhythm to resetting by short wavelength light. J Clin Endocrinol Metab 88:4502–4505. https://doi.org/10.1210/jc.2003-030570CrossRefPubMed

60.

Raikes AC, Dailey NS, Shane BR et al (2020) Daily Morning Blue Light Therapy improves daytime sleepiness, Sleep Quality, and Quality of Life following a mild traumatic brain Injury. J Head Trauma Rehabil 35:E405. https://doi.org/10.1097/HTR.0000000000000579CrossRefPubMed

61.

Wang T, Li J, Wang Y et al (2022) Active interventions of dynamic lighting on human circadian rhythm and sleep quality in confined spaces. Build Environ 226:109766. https://doi.org/10.1016/j.buildenv.2022.109766CrossRef

62.

Li D, Fang P, Liu H et al (2022) The clinical effect of Blue Light Therapy on patients with delayed sleep-wake phase disorder. Nat Sci Sleep Volume 14:75–82. https://doi.org/10.2147/NSS.S344616CrossRef

63.

Viola AU, James LM, Schlangen LJ, Dijk D-J (2008) Blue-enriched white light in the workplace improves self-reported alertness, performance and sleep quality. Scand J Work Environ Health 34:297–306CrossRefPubMed

64.

Ong JC, Taylor HL, Park M et al (2018) Can Circadian Dysregulation Exacerbate migraines? Headache J Head Face Pain 58:1040–1051. https://doi.org/10.1111/head.13310CrossRef

65.

Main A, Vlachonikolis I, Dowson A (2000) The Wavelength of Light causing Photophobia in Migraine and Tension-type headache between attacks. Headache J Head Face Pain 40:194–199. https://doi.org/10.1046/j.1526-4610.2000.00028.xCrossRef

66.

Boardman HF, Thomas E, Millson DS, Croft PR (2005) Psychological, Sleep, Lifestyle, and Comorbid associations with Headache. Headache J Head Face Pain 45:657–669. https://doi.org/10.1111/j.1526-4610.2005.05133.xCrossRef

67.

Martin PR, MacLeod C (2009) Behavioral management of headache triggers: avoidance of triggers is an inadequate strategy. Clin Psychol Rev 29:483–495. https://doi.org/10.1016/j.cpr.2009.05.002CrossRefPubMed

68.

Kelman L (2007) The triggers or precipitants of the Acute Migraine Attack. Cephalalgia 27:394–402. https://doi.org/10.1111/j.1468-2982.2007.01303.xCrossRefPubMed

69.

Houle TT, Butschek RA, Turner DP et al (2012) Stress and sleep duration predict headache severity in chronic headache sufferers. Pain 153:2432–2440. https://doi.org/10.1016/j.pain.2012.08.014CrossRefPubMedPubMedCentral

70.

Figueiro MG (2013) An overview of the effects of Light on Human circadian rhythms: implications for New Light sources and Lighting Systems Design. J Light Vis Environ 37:51–61. https://doi.org/10.2150/jlve.IEIJ130000503CrossRef

71.

Rea MS, Nagare R, Figueiro MG (2020) Predictions of melatonin suppression during the early biological night and their implications for residential light exposures prior to sleeping. Sci Rep 10:14114. https://doi.org/10.1038/s41598-020-70619-5CrossRefPubMedPubMedCentral

72.

Burgess HJ, Park M, Ong JC et al (2017) Morning Versus Evening Bright Light Treatment at Home to improve function and Pain Sensitivity for women with Fibromyalgia: a pilot study. Pain Med 18:116–123. https://doi.org/10.1093/pm/pnw160CrossRefPubMed

73.

Noseda R, Bernstein CA, Nir R-R et al (2016) Migraine photophobia originating in cone-driven retinal pathways. Brain 139:1971–1986. https://doi.org/10.1093/brain/aww119CrossRefPubMedPubMedCentral

Title: Photophobia is associated with lower sleep quality in individuals with migraine: results from the American Registry for Migraine Research (ARMR)
Authors: Nina Sharp
Mark J Burish
Kathleen B Digre
Jessica Ailani
Mahya Fani
Sophia Lamp
Todd J. Schwedt
Publication date: 01-12-2024
Publisher: Springer Milan
Keywords: Migraine
Headache
Insomnia
Anxiety
Mood Disorders
Affective Disorder
Published in: The Journal of Headache and Pain / Issue 1/2024
Print ISSN: 1129-2369
Electronic ISSN: 1129-2377
DOI: https://doi.org/10.1186/s10194-024-01756-9

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Photophobia is associated with lower sleep quality in individuals with migraine: results from the American Registry for Migraine Research (ARMR)

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2024

Safety and tolerability of atogepant for the preventive treatment of migraine: a post hoc analysis of pooled data from four clinical trials

The crucial role of locus coeruleus noradrenergic neurons in the interaction between acute sleep disturbance and headache

Is erenumab an efficient alternative for the prevention of episodic and chronic migraine in Spain? Results of a cost-effectiveness analysis

Poor healthy lifestyle and life’s essential 8 are associated with higher risk of new-onset migraine: a prospective cohort study

Harris Poll Migraine Report Card: population-based examination of high-frequency headache/migraine and acute medication overuse

The prevalence and demographic associations of headache in the adult population of Peru: a national cross-sectional population-based study