Two unique, yet related symptoms frequently rise to the top of the list for people with chronic conditions: photophobia and phonophobia. Interestingly, they rarely appear in isolation, indicating shared physiological processes may exist between them. In this post, we explain what these medical terms represent and why they often occur together.
What is photophobia and phonophobia?
Most people probably are not familiar with the terms photo- or phonophobia, unless they have learned of them through a conversation with their doctor or specialist. So let's start with the definitions behind these medical terms:
Photophobia: Abnormal sensitivity to light
Phonophobia: Abnormal sensitivity to sound
People with photophobia often complain of light being too bright or fluorescents being bothersome. Computer or device screens, outdoor sunlight and glare can also negatively impact people with this symptom.
Phonophobia similarly represents a strong intolerance to one's environment, specifically sound. Although the term may evoke the concept of fear, for those with chronic illness it generally represents a sensitivity to loud noises—such as traffic, music or even talking.
How often do photophobia and phonophobia occur together?
The extent to which both of these symptoms are present depends on the specific condition which causes them. Here are a just a handful of the disorders that can bring on these issues:
- Migraine and headache conditions
- Traumatic brain injuries, concussions
- Attention Deficit Hyperactivity Disorder (ADHD)
- Autism Spectrum Disorders
In the case of migraine, hypersensitivity to bright lights and loud noises are both included as part of the diagnosis for the headache disorder. Amazingly, these sensitivities are far and away the most common problems after headache, with more than 85% experiencing them during attacks.1 People with migraine also have elevated light- and sound-related discomfort between their attacks, more so than most other symptoms.2
Although less prominent than traditional migrainous symptoms, patients with other headache disorders (cluster headache, tension-type headache, etc.) are similarly affected by light and noise.3,4
Head or brain injuries can also be associated with photo- and phonophobia. These issues are more commonly linked with the longer term neurological effects of concussions but still negatively impact people in the first few days or weeks after an injury.5 Light tends to be a bigger problem for survivors, but at least one-quarter—and probably higher—are likely to have either or both symptoms. Veterans in particular who have suffered a mild traumatic brain injury (such as through blast exposure during combat) may be at even greater risk.
Lastly, people with fibromyalgia and other sensory processing disorders (ADHD, Autism) have to deal with heightened sensitivity to their environment. Other sensations also come into play with these conditions, including negative or painful responses to touch or smell—although people with migraine can also experience these problems as well.6
It is worth pointing out that light and noise have been separately identified as triggering factors for many patients too. This is likely an extension of these broader sensory sensitivities and are equally influenced by changes in the brain associated with their conditions. And although there is question over the extent to which they can bring about pain or other symptoms, we must take them into account given how common it appears to be.
Why do light and sound sensitivity co-exist?
It still remains a medical mystery as to exactly why these and other conditions jointly cause photophobia and phonophobia, but researchers have identified a few possible explanations.
Obviously, the main reason for these symptoms occurring in tandem is the result of the disorders themselves. Time and time again, studies have shown that one of their primary effects is to impair the central nervous system, which is responsible for how we interpret our surroundings. As a result, this can create a myriad of reactions that characterize photophobia and/or phonophobia, including:7,8
- Stronger negative responses to environmental stimuli, including symptoms of light or sound sensitivity as well as of their condition
- A reduced overall tolerance for light and sound, making even appropriate levels seem excessive or even painful
- Overstimulation of the brain causing an inability to correctly process one’s surroundings, which may also be compounded by psychological distress
Recently, other experts have identified direct connections between the visual and auditory systems and related activity in the brain for people with migraine. These systems become activated during attacks and thus lead to the sensory symptoms that many patients describe. Interestingly, those with anxiety or panic disorders may also experience comparable activity, furthering the link with anxiety-related sensitivities.
Lastly, complicating factors can increase the likelihood of photophobia or phonophobia. Anxiety, stress and/or comorbid emotional disorders (such as PTSD) have been shown to amplify a person’s physiological response to their surroundings. It is unclear why this happens, but it may be enhanced by the avoidance behaviors—such as isolating in a dark room—that many adopt in order to steer clear of bright or loud places. Reducing one’s exposure can have the opposite effect over time by worsening sensory sensitivities.
Read more about light sensitivity:
1Lipton RB, Munjal S, Alam A, Buse DC, Fanning KM, Reed ML, Schwedt TJ, Dodick DW. Migraine in America Symptoms and Treatment (MAST) Study: Baseline Study Methods, Treatment Patterns, and Gender Differences. Headache. 2018 Oct;58(9):1408-1426. doi: 10.1111/head.13407. Epub 2018 Oct 20.
2Main A, Dowson A, Gross M. Photophobia and phonophobia in migraineurs between attacks. Headache. 1997 Sep;37(8):492-5.
3Vingen JV, Pareja JA, Stovner LJ. Quantitative evaluation of photophobia and phonophobia in cluster headache. Cephalalgia. 1998 Jun;18(5):250-6.
4Vanagaite Vingen J1, Stovner LJ. Photophobia and phonophobia in tension-type and cervicogenic headache. Cephalalgia. 1998 Jul-Aug;18(6):313-8.
5Waddell PA, Gronwall DM. Sensitivity to light and sound following minor head injury. Acta Neurol Scand. 1984 May;69(5):270-6.
6Wilbarger JL, Cook DB. Multisensory hypersensitivity in women with fibromyalgia: implications for well being and intervention. Arch Phys Med Rehabil. 2011;92(4):653-6.
7Yang G, Baad-Hansen L, Wang K, Xie QF1, Svensson P. Effect of negative emotions evoked by light, noise and taste on trigeminal thermal sensitivity. J Headache Pain. 2014 Nov 7;15:71. doi: 10.1186/1129-2377-15-71.
8Howe FEJ, Stagg SD. How Sensory Experiences Affect Adolescents with an Autistic Spectrum Condition within the Classroom. Journal of Autism and Developmental Disorders. 2016;46:1656-1668. doi:10.1007/s10803-015-2693-1.