It has been often described that cluster headache is one of the worst pains imaginable, in some cases even more than an unbreakable migraine attack. However, there is still confusion about what exactly triggers cluster bouts as well as the type of symptoms that a patient might experience.
Light sensitivity and photophobia, in particular, are symptoms that are not generally linked to cluster headache, although both clinical research and patient experience would dictate that it is far more common than we may realize. Here is an online anecdote from one cluster patient:
"I've been [chronic cluster headache patient] for a little over a year now and pretty recently I've noticed that whenever I go outside and enter the sunlight, within minutes I start to feel a headache coming on. I've figured out that its that apparently I'm like ultra sensitive to light. By the way it isn't limited to the sun sometimes [I'll] be on my computer or my iPhone and even the brightness from those will cause headaches."
Some have even used the term “cluster migraine” to account for the migrainous features of cluster patients, although that is not a recognized diagnosis. Still, there is growing consideration to revise the International Classification of Headache Disorders guidelines for cluster headache to better reflect recent analysis. In this post, we break down everything we know about the role that light can play in the experiences of cluster headache.
Light Sensitivity as a Pre-Attack Symptom
Generally, anywhere between 2% to 20% of cluster headache patients must deal with pre-attack symptoms, or aura, although the numbers may actually be much higher.1,2 And the majority of these symptoms tend to be visual in nature, with about 15% dealing with photophobia prior to a cluster bout.2 This strong intolerance to light typically begins within 15 minutes of the attack—along with other issues such as neck pain, nausea or dull aching—and can last throughout the episode.3 Amazingly, more than half can also expect to experience ongoing light sensitivity after the acute attack is over.
Light as Trigger for Cluster Headaches
Bright lighting makes just about every trigger list for cluster headache, but how likely is it to actually bring on an attack? According to clinical studies, bright or flashing lights as well as sunlight can trigger cluster bouts for nearly a quarter of patients, and you may be at even greater risk if you already endure photophobia, with fluorescent lighting being particular bothersome.4,5 Many experts do agree that those who report light as a direct trigger are likely to have underlying migraine-related issues, which further makes accurate diagnosis from a headache specialist critical for cluster care.
Light Sensitivity During an Attack
Although auxiliary symptoms of cluster headache are regularly overlooked, photophobia is reported as a symptom by well over half of cluster patients—even in those with no prior history of migraine.6,7 The location of the photophobic discomfort does however differ from migraine, occurring more often on one side of the head, which is common for both the head pain as well as other sensory symptoms. Furthermore, the presence of light sensitivity is not shown to influence the overall pain rating, although it is likely that this is due to the already-high intensity of cluster bouts. And photophobia generally affects men and women equally. Ultimately, the research reinforces that light sensitivity can be a major problem for people with cluster headache.
How Can You Reduce Cluster-Related Light Sensitivity?
We spend a lot of time and energy helping educate light-sensitive individuals on ways that they can minimize the painful effects of light. The key is to not avoid light altogether and recognize that there are options for relief because, at the end of the day, you want to be able to live your life out in the open—not hiding in a dark room. Not only can TheraSpecs precision-tinted glasses help with photophobia, but we have countless informational resources as well which we encourage you to check out. We have included many of them below.
1Martínez-Fernández E, Alberca R, Mir P, Franco E, Montes E, Lozano P. Cluster headache with aura. The Journal of Headache and Pain. 2002;3(2):105-110. doi:10.1007/s101940200026.
2Rozen TD. Cluster headache with aura. Curr Pain Headache Rep. 2011 Apr;15(2):98-100. doi: 10.1007/s11916-010-0168-9.
3Snoer A, Lund N, Beske R, Jensen R, Barloese M. Pre-attack signs and symptoms in cluster headache: Characteristics and time profile. Cephalalgia. 2018 May;38(6):1128-1137. doi: 10.1177/0333102417726498. Epub 2017 Aug 17.
4Rozen TD, Fishman RS. Cluster headache in the United States of America: demographics, clinical characteristics, triggers, suicidality, and personal burden. Headache. 2012 Jan;52(1):99-113. doi: 10.1111/j.1526-4610.2011.02028.x. Epub 2011 Nov 11.
5Bullock G. The Impact of Light Sensitivity. Retrieved from: https://www.theraspecs.com/impact2017/.
6Vingen JV, Pareja JA, Stovner LJ. Quantitative evaluation of photophobia and phonophobia in cluster headache. Cephalalgia. 1998 Jun;18(5):250-6.
7Bahra A, May A, Goadsby PJ. Cluster headache: A prospective clinical study with diagnostic implications. Neurology Feb 2002, 58 (3) 354-361; DOI: 10.1212/WNL.58.3.354.