Headaches with Light Sensitivity: Types, Risk Factors, and Treatments

Headaches with Light Sensitivity: Types, Risk Factors, and Treatments

Written by Greg Bullock on 12th Jun 2021

When does a headache become something more? One of the simplest answers is when that headache features other symptoms, especially if they have never been experienced before. While it doesn’t immediately signal a serious danger, it can still be scary for the person enduring the pain or discomfort. Light sensitivity, also known as photophobia, may be among the most common symptoms that is paired with a variety of headache types and disorders. Let's explore them in depth.

Types of Headaches with Light Sensitivity

Infographic showing different types of headaches with light sensitivity

Migraine and Migraine Subtypes

We have to start with the obvious: migraine is not a headache. It is, however, a primary headache disorder that affects millions of people and which often features head pain and light sensitivity as core symptoms. In fact, 80-90% of those diagnosed with migraine deal with light-related pain during their attacks. It frequently requires them to take adaptive measures to avoid or limit their light exposure, such as finding a dark room and/or wearing sunglasses or therapeutic eyewear to cope.

In fact, migraine and photophobia are connected on a physiological level. The way a migraine brain processes light is different from the average brain in that certain parts of the brain become activated during a migraine attack, which translates to sensory sensitivities. In addition, people with migraine have less tolerance for light overall, which explains why bright lights can trigger headache pain (even if they’re not actually that “bright”) as well as why photophobia can manifest before or after an attack too.

And whether you have migraine with or without aura, vestibular migraine or another subtype of the headache disorder, light sensitivity has been shown to affect every variation similarly.

Tension-Type Headache

Tension or tension-type headaches are what most of us are likely to think of as an “average headache”—especially in the absence of a preexisting condition. Maybe we spent too much time on our devices, our stress levels increased unexpectedly, and/or we didn't get enough sleep the night before, all of which can turn into this type of head pain. The name generally describes a wraparound throbbing that makes it feel like your brain is being squeezed; it usually dissipates within a few hours (especially with pain relieving medication or other interventions), but it can also bring along a variety of other symptoms like sensitivity to light.

While no definitive estimate exists for how frequently photophobia occurs in tension headaches, evidence suggests it may affect at least 25% of people—and perhaps as much as 90 percent—during the headache phase. However, if light sensitivity is coupled with sound sensitivity (which it often is for other conditions), then it ceases to be a tension-type headache and becomes another category altogether. Furthermore, photophobia generally has a lower impact for tension headaches when compared with other headache types.

New Daily Persistent Headache (NDPH)

New daily persistent headache (NDPH) describes a sudden onset of regular headaches with no prior diagnosis and no signs of worsening symptoms beforehand, along with unremitting episodes of pain. Many patients who develop NDPH can recall the specific moment or day when they experienced their first (of what would become almost-daily) headaches. Migraine-like symptoms are very common with this headache disorder, specifically nausea and photophobia, and intolerance to light has been specifically shown to impact as much as two-thirds of people with NDPH.1 However, it does not appear that light triggers these daily headaches in the way that it does for migraine.

Cluster Headache

One of the most unique and challenging headache types that can feature photophobia is cluster headache. In addition to the intense pain associated with this condition, the headaches arrive in a series or “cluster” (hence the name), ranging in frequency from one every other day to as many as eight per day. The textbook definition of cluster headache does not include sensitivity to light as an identifiable symptom, but those who have been diagnosed with cluster headache can regularly exhibit migraine-like complications, including sensory sensitivity. This means photophobia can appear before, during or after a cluster bout, and it does in over 50% of patients—even without any prior migraine history.

Post-Traumatic Headache

Millions of people every year endure a mild traumatic brain injury (TBI), known as a concussion, during athletic or recreational activities, and many individuals also sustain more severe traumas to their brain. Given the highly complex mechanisms that connect the eyes and the brain, any injury that impairs either of them is likely to lead to headache and photophobia symptoms, like we see in those with post-traumatic headache. Depending on the severity of the injury, light sensitivity can range from 35-55% of individuals after a TBI.

Post-TBI headaches are considered a secondary disorder because it is directly attributable to the injury, unless a preexisting headache disorder is worsened by TBI or a new type of headache develops. This makes it a challenge to pin down because they can mirror any of the primary headache and migraine disorders we have already described, from specific headache characteristics to light sensitivity symptoms and triggers.

Headache Due To Infection

Like those with post-traumatic causes, headache disorders that develop as a result of an infection are considered a “secondary headache” condition. Headache-related side effects are actually quite common from bacterial and viral infections, particularly during the acute phase, and can become longer-term concerns for some patients. These headaches often resemble migraine and can be characterized by light sensitivity and other visual or neurological symptoms.

For example, meningitis causes swelling around the brain which can result in photophobia symptoms, present in between 50-80% of people. It may be more rare in conditions like Lyme Disease, but no less disabling. More recently, COVID-19 infections have led to a rise in acute and persistent headache and light sensitivity complications, which are just now beginning to be studied. And in all of these cases, sensitivity to light may be underreported since it is often not considered a core symptom of the infection.

Ocular-Based Headaches

Many conditions can cause visual and neurological symptoms, but some originate in the eye and lead to headaches with photophobia. Dry eye syndrome, for example, regularly results in headaches and can lead to light-sensitive reactions in as much as 75% of people with the condition—due to a multitude of factors that are impairing pathways from the eye to the brain. We also have to recognize that dry eye symptoms and diagnoses often accompany other conditions (e.g. migraine and traumatic brain injury), which further complicates matters.

Similarly, glaucoma can bring on head pain and light sensitivity. Increased pressure in and around the eye from glaucoma can negatively impact the brain and lead to the presence of both symptoms, with approximately 20% experiencing sensitivity to light. While glaucoma-related photophobia is often experienced in different ways when compared with other conditions, it still has a disabling effect for patients.

TMD/TMJ Headache

It may not be immediately obvious that a disorder of the jaw or mouth would lead to headaches, but it can when it involves the temporomandibular joint (TMJ) because of its connection directly to the skull. Disorders associated with the muscles, joints and nerves in this region can have a dramatic effect on chronic or recurring facial pain, ultimately leading to headaches. It even has its own place in the International Classification of Headache Disorders.

Light sensitivity and related sensory symptoms are not included in the criteria for headaches attributed to temporomandibular disorders (TMD), and so we do not have a great understanding of how prevalent photophobia is for people. Still, many patients with TMD describe their headache as “migrainous,” meaning it feels like a migraine attack, and photophobia has been shown to accompany this pain—even though it is far less prominent in TMD versus other headache conditions.2

Aggravating Risk Factors

Many of the aforementioned headache types can be attributed to a singular cause (e.g. a brain injury or a tension-type headache from smartphone screen exposure), but some—like migraine—may have no discernible cause. They may build over time before developing into a full-blown primary headache disorder or, in the case of new daily persistent headaches, simply appear one day without warning. This makes risk factors particularly difficult to characterize, and they will certainly vary depending on the specific diagnosis.

Migraine, for example, is believed to have a genetic component, making patients with a family history of headache disorders more susceptible. Certainly women are more likely to experience headaches and/or be diagnosed with them, so that can qualify as a risk factor for most types as well.

What about headaches with sensitivity to light? If you have recurring head pain or have been diagnosed with one of these disorders, you are already more likely to endure photophobia relative to most conditions. In addition, if you have migraine (any subtype), there is a higher likelihood that light sensitivity will accompany your symptoms as part of the headache or attack phase—simply given the higher percentage of patients who report it.

Additional complications to be aware of include:

Other sensory symptoms: If people already display sensitivity to their surroundings, whether it be sound or touch, then this may indicate that the underlying pathways for pain (and similarly photophobia) have been impacted. We know that phonophobia, or sound intolerance, regularly pairs with light sensitivity; so if you are sensitive to noise, then you may also feel discomfort under bright lights.

Comorbid diagnoses: There are a wide range of conditions that co-occur with headache disorders, such that it makes it difficult to understand their exact connection. Still, the mere presence of these comorbid conditions—especially if they cause other visual and neurological deficits—can increase the likelihood that you will have headaches or migraine attacks with photophobia. Fibromyalgia and Autism Spectrum Disorders are among those commonly linked to headache and light sensitivity symptoms.

Intensity of light exposure: Since many headache disorders result in a lower overall threshold for light, the relative brightness of the source plays a critical role in the onset of photophobia with headache. As we’ve discussed in other articles, for people with migraine, the intensity of sunlight on a summer day can trigger their symptoms within just a few minutes, even with full eye protection.

Wavelengths of light exposure: Our eyes are naturally sensitive to blue light at 480nm, but something about the impacted pathways from the eye to the brain (inherent in many headache disorders) further increases this light-induced pain. Moreover, this is the wavelength that was shown to be the most likely to trigger migraine attacks and related symptoms in patients—even at different luminance levels.3 As a result, everything from our computer and device screens to walking outside on a sunny day can expose us to 480nm blue light. We don’t know exactly how much is “too much” of this wavelength, but the risk is always there.

Lack of eye protection: If you are aware that you get headaches with light sensitivity, then it is incumbent to take steps to reduce the impact—especially when you factor in the brightness and blue light wavelengths that can also worsen the problem. From wearing high-quality and protective sunglasses outside to therapeutic eyewear indoors, a few simple steps can make all the difference between pain and no pain.

Wearing sunglasses indoors or avoiding light altogether: When you isolate yourself in complete darkness, you run the risk of worsening your light sensitivity over time. Momentary relief during a headache and light-sensitive episode is unlikely to cause long-term problems, but repeated exposure to low lighting eventually adapts your eyes and makes them less tolerant of light over the long haul. And if you are increasingly sensitive to light, then there is a higher likelihood that it will trigger headaches too.

Treatments for Light-Sensitive Headaches

Infographic showing how to treat light-sensitive headaches

Diagnosis and treatment

The first step before any photophobia treatment recommendation is to consult with a doctor or headache specialist. Diagnoses of headache disorders require significant triangulation of symptoms, headache onset, and other experiences, which makes it vital to work with a professional.

The next step is to listen to your doctors and specialists! While not every treatment option they suggest will work, most have vast experience working with similar headache patients and knowledge of the various treatments; they have seen just about everything and even when it seems nothing will work, many never give up in the search far and wide to find something that does. And of course, if you are not happy with your current headache treatment, then don’t be afraid to speak up. It may even be necessary to seek out a new treatment team that better aligns with your goals and experiences.

Medications

While no drug exclusively targets light sensitivity, a wide variety of headache-specific medications can help reduce the impact of both the head pain and the photophobia. Triptans have been widely advised in the treatment of acute headaches and migraines, along with their corresponding symptoms. Botox, although primarily used for cosmetic reasons, has also been effective for dry eye, TBI and migraine-related light sensitivity.

There continues to be new advancements in this area as well. For example, CGRP inhibitors were recently developed specifically for migraine to target the pathways that are believed to play a role in the onset of attacks—and they have shown promising success. Plus, in most cases, these and other medications can help relieve the “most burdensome symptom,” which tends to be photophobia and light sensitivity.

Other therapies for photophobia

Therapeutic products can also significantly cut down on the wavelengths and/or intensity that triggers and worsens light sensitivity. TheraSpecs blue light glasses for migraine and headache disorders remove more blue light at 480nm than similar tinted glasses, making them a highly-effective remedy for photophobia—without side effects. TheraSpecs are also available as dark blue light sunglasses that are better than other high-quality sunglasses.

If you can’t try TheraSpecs, you definitely want dark and polarized sunglasses that eliminate 100% UVA/UVB light for outdoor use. And if you find that light coming in from the top or sides is problematic, you should look for eyewear that adds wraparound side protection, large lens coverage, and additional anti-reflective lens coatings. You may also want to avoid translucent or see-through frames in which light can pass through it, and a non-glossy matte finish on the frame might help lower the reflectiveness.

Behavioral changes can also enhance your overall comfort with certain light sources, although their effectiveness can be highly variable, such as:

  • Taking your prescribed headache medications at the onset of any pain or photophobia
  • Activating dark mode, color shift and other accessibility settings or applications for your screens
  • Managing your screen time, especially when it triggers your symptoms
  • Avoiding high-contrast or flashing light environments, which can negatively harm people that are susceptible to headaches
  • Limiting your exposure to fluorescent lighting, which not only emits triggering blue light but also has an invisible flicker that aggravates sensitive brains
  • Mitigate the impact of other headache triggers, especially if you are unable to control the lighting within your environment

With the right combination of professional guidance, prescription therapeutics and products, and lifestyle modifications, you can lower the impact of light-sensitive headaches.

More on Light Sensitive Headache Types

How Migraine Attacks Can Be Triggered or Worsened by Light

Photophobia, Light Sensitivity after Traumatic Brain Injury

Headaches and Light Sensitivity During and After COVID-19 Infection

10 Amazing Facts about Light Sensitivity and Headaches

References:

1Yamani N, Olesen J. New daily persistent headache: a systematic review on an enigmatic disorder. The Journal of Headache and Pain. 2019;20(1). doi:10.1186/s10194-019-1022-z.

2Schiffman E, Ohrbach R, List T, et al. Diagnostic criteria for headache attributed to temporomandibular disorders. Cephalalgia. 2012;32(9):683-692. doi:10.1177/0333102412446312

3M. Tatsumoto, T. Eda, T. Ishikawa, M. Ayama, K. Hirata “Light of Intrinsically Photosensitive Retinal Ganglion Cell (ipRGC) Causing Migraine Headache Exacerbation.” IHC symposium OR3. 2013 June

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