Patients with migraine-related light sensitivity (also known as photophobia) may be at greater risk for depression, anxiety and stress, according to a new study from The Journal of Headache and Pain. Researchers specifically assessed individuals who had migraine without aura and also experienced photophobia during migraine attacks (‘ictal photophobia’) as well as between attacks (‘interictal photophobia’). Not only did they report greater levels of sensitivity to light than those without migraine, but feelings and symptoms of mental or emotional distress were also more pronounced than their non-migraine counterparts.
The link between migraine, photophobia and emotional disorders has already been a prominent subject in prior research. A 2016 study found that photophobia between migraine episodes positively correlated with depression and anxiety when compared with both non-photophobic migraineurs as well as migraine-free patients.(1) In addition, light sensitivity has been connected to lower pain tolerances toward light in general, especially for people who have already been diagnosed with a panic disorder.(2) As a result, greater pain severity could be an influential factor.
The American Migraine Foundation further estimates that people who have migraine—regardless of photophobia—are two to five times more likely to exhibit symptoms of depression or anxiety. They also have higher rates of disability and are at an increased risk for suicide than those without mental or emotional disorders. These issues are even higher for people with chronic migraine. Worse yet, stress and anxiety have been independently shown to be triggers for migraine, in effect creating a negative physical and emotional cycle for people with the headache disorder.(3) The researchers behind this new study also added that depression may not just increase attack frequency but may actually worsen light sensitivity between attacks as well.
Why does photophobia increase the prevalence of emotional disorders?
There are numerous hypotheses for why depression, anxiety and stress are seen more frequently in people with migraine and photophobia. Diminished quality of life and loss of personal and professional productivity could certainly contribute to these feelings, particularly in those with chronic migraine. Furthermore, excessive trigger avoidance may also lead to social isolation in an effort to avoid situations that could bring on an attack. Those specifically with photophobic symptoms are likely to fear exposure to certain light-related triggers (such as sunlight, fluorescent lighting, or other bright lights) during migraine-free periods; this may not only increase feelings of anxiousness but, if they also shut themselves off from regular activities, then it could further these types of mood-related symptoms.
The authors of this latest study have also suggested that physiological “coping mechanisms” may exist in how pupils dilate during stressful or anxiety-inducing situations for people who have migrainous photophobia. Medication side effects and other biological explanations may also exist. And there have also been numerous genetic associations between migraine and depression as well.(4)(5) Ultimately, we do not have a definitive answer as to why, but there are clear connections between the conditions.
What are signs of migraine-related depression or anxiety?
Depression and anxiety affect everyone individually, but it is important to recognize that symptoms of these disorders are uncontrollable and persist for several weeks or more. Some of the signs might include feelings of prolonged hopelessness, sadness, or apathy. Anxiety might be depicted by constant worry, fear or negative expectations. Appetite changes, lethargy, and difficulties in concentration are other possible indicators. People with migraine might also develop an unhealthy focus on the their attacks—even when they are not experiencing one—or the impact it has on their lives. Furthermore, they may become increasingly withdrawn from regular social interactions or activities, especially ones that risk exposing them to light or other environmental triggers.
How can depression be treated in people with migraine?
There is rarely a catch-all treatment method for somebody with migraine, much less for a person who also has been diagnosed with other comorbid conditions such as depression. As a result, it often takes a comprehensive approach that could include psychotherapy, medication, and behavioral changes coupled with ongoing migraine prevention techniques.
The first step is to acknowledge any troubling thoughts or behaviors that you or a loved one may be having, and then to discuss them openly with your doctor or headache specialist. They can work with you to develop a treatment plan for your migraine attacks, migraine-related photophobia, as well as any mood or emotional disorders. They can also refer you to any mental health professionals, if appropriate. Furthermore, they can help you identify external triggers for your migraines so that you can develop proactive prevention resources that do not result in avoidance behaviors. Not surprisingly, if you are able to reduce the negative impact of migraine in your life, this can also reduce corresponding symptoms of photophobia, depression and/or anxiety.
Further research is warranted in better understanding the relationship between migraine and emotional disorders. But the key thing to remember is that depression and anxiety are treatable in individuals with migraine. You are not alone if feel a heavy burden associated with the headache disorder, and there are many resources available to help you navigate those difficult feelings.
1 Llop S, Frandsen J, Digre K, Katz B, Crum A, Zhang C, Warner J. Increased prevalence of depression and anxiety in patients with migraine and interictal photophobia. The Journal of Headache and Pain. 201617:34. DOI: 10.1186/s10194-016-0629-6.
2 Bossini L, Fagiolini A, Valdagno M, Padula L, Hofkens T, Castrogiovanni P. Photosensitivity in panic disorder. Depress Anxiety. 2009;26(1):E34-6. doi: 10.1002/da.20477.
3 Sauro KM, Becker WJ. The stress and migraine interaction. Headache. 2009 Oct;49(9):1378-86. doi: 10.1111/j.1526-4610.2009.01486.x. Epub 2009 Jul 8.
4 Ligthart L, Nyholt DR, Penninx BW, Boomsma DI. The shared genetics of migraine and anxious depression. Headache. 2010 Nov;50(10):1549-60. doi: 10.1111/j.1526-4610.2010.01705.x.
5 Stam AH, de Vries B, Janssens ACJW, et al. Shared genetic factors in migraine and depression: Evidence from a genetic isolate. Neurology. 2010;74(4):288-294. doi:10.1212/WNL.0b013e3181cbcd19.