What We Know about Vestibular Migraine and Light Sensitivity

What We Know about Vestibular Migraine and Light Sensitivity

Posted by Greg Bullock on 6th May 2019

We have already discussed the broader implications of light sensitivity and dizziness, but there is so much more to unpack when it comes to this symptom’s impact on vestibular disorders. In this post, we take a deeper dive into how photophobia and light sensitivity specifically affects vestibular migraine.

As a reminder, vestibular migraine differentiates itself from other subtypes of headache disorders because its core symptoms revolve around dizziness (in addition to the usual migraine complications). If you are not familiar with vestibular migraine, read our in-depth guide here.

Photophobia equally affects vestibular migraine as other migraine types

Light sensitivity is part of the ICHD-3 criteria for vestibular migraine, with at least half of attacks featuring this painful symptom along with primary vestibular issues like vertigo and lightheadedness. When researchers actually investigated how often photophobia accompanies vestibular migraine episodes, they found that 90% of patients endured strong sensitivities to their environment—which is comparable with just about all other types of migraine. In fact, headache as a direct symptom was far less prominent!1 This just further reinforces that migraine (including the vestibular subtype) is NOT just a headache, but instead features sensory and vestibular dysfunction for many.

Furthermore, over 70% of children with vestibular migraine also report having photophobic symptoms; although it may seem less widespread than adults, it is possible that it is underreported because children often have a hard time describing their light sensitivity. Unfortunately, heightened sensitivities regularly impact about 10% of vestibular migraine patients between attacks too, supporting previous research that interictal symptoms (as they are called) are a common complaint.1,2

Bright light is a prominent trigger for attacks and symptoms

As if it were not enough to have light-related pain during a vestibular episode, bright lighting also has the ability to bring on an attack. Triggers tend to be highly variable for patients, but light still presented in the top-3 for vestibular migraine attacks—with more than one-quarter of those with the condition believing it triggered their dizziness and vertigo. Only stress was more likely to activate an attack.1 We also cannot discount other visual triggers that made the list, notably flashing lights.

Fluorescent lighting seems to represent the most problematic of sources for light-sensitive vestibular migraine, but any light exposure can bring about symptoms. Like other migraine types, those with migrainous vertigo have less tolerance for light too, which makes them more susceptible to light-induced vestibular problems. Basically, the mere fact of having migraine makes light feel more bright (and even painful) than it actually is. And this leads to hallmark vestibular migraine symptoms such as:

  • Vertigo (spontaneous, visual or positional)
  • Lightheadedness
  • Nausea and/or vomiting
  • Headache
  • Poor or impaired balance
  • Light, sound and/or touch sensitivity

And these physical manifestations can last anywhere from a few minutes to a few days.

Interaction between the trigeminal and vestibular systems may cause sensitivity to light

We do not know why vestibular migraine occurs, nor do we understand exactly why light plays such a harmful role for patients. However, experts have suggested that there is a shared connection between the trigeminal and vestibular systems that affect pain sensation and processing.3 Causes of photophobia also have roots in the trigeminal nerve, which may explain its frequent occurrence with vestibular attacks. Additional studies have shown elevated activity in parts of the brain that involve both visual processing and vestibular functioning, perhaps pointing to another pathway for vestibular migraine-related light sensitivity.4

Photophobia may develop after diagnosis and/or last for several years

Of course, we know that migraine does not have a cure, and although symptoms can change (if not reduce) over time, people endure symptoms for much of their adult lives. Similarly, as there are no medications for light sensitivity, they are likely to live with it for as long as they have the headache disorder. In fact, one study revealed that 80% still had sensitivity to light an average of nine years after the initial diagnosis; what’s worse is that there appeared to be a delay in the onset of numerous symptoms, including photophobia, with more reporting it several years after its onset.5 Lastly, certain behaviors can worsen light sensitivity—such as wearing dark sunglasses inside—during this time, which may contribute to its persistence.

Other conditions can make diagnosis and treatment difficult

Migraine is known to lead to countless conditions that complicate the patient experience. Perhaps the most unique concern is Meniere’s Disease, which is an inner ear disorder that also regularly features migrainous symptoms. Surprisingly, 40-50% of Meniere’s attacks can include light sensitivity and other sensory dysfunction.6 Furthermore, episodic vertigo is a common feature of general migraine, and many patients may not even develop vestibular symptoms until later in life. All of these issues can make it hard for definitive vestibular migraine diagnoses.

We also mentioned previously that visual vertigo presents its own unique issue because of the fact that disorienting environments are responsible for vestibular attacks. Oftentimes, bright and/or flashing lights characterize these environments, compounding the visual discomfort for patients and making its confirmation as a trigger difficult.

TheraSpecs lenses can be effective for vestibular-related light sensitivity

Although more directed research is needed to specifically link precision-tinted TheraSpecs lenses to vestibular migraine relief, several studies have generally supported the effectiveness of the tint for reducing migraine attacks, fluorescent light sensitivity and other symptoms.7,8 They are particularly great for cutting down on our exposure to the blue-green light and invisible pulsing of old-style fluorescents. Even without direct study, our team continues to hear from vestibular migraine patients who use TheraSpecs on a daily basis as a tool for their photophobia. Here are a few of their stories:

"TheraSpecs Help Me Get Through Most Days" (Shelly’s Story) ➜

"I Have Found My Smile Again" (Tara’s Story) ➜

If light bothers your vestibular migraine, we encourage you to try TheraSpecs. With our 60-day return policy on non-prescription styles, you can make sure they provide relief without the risk of other expensive treatments.


More Information about Migraine & Light Sensitivity

How Migraine Attacks Can Be Triggered or Worsened by Light

The Ultimate Guide to Photophobia and Light Sensitivity

Flashing Lights Are The Worst for Migraine

10 Amazing Facts about Light Sensitivity & Headache Disorders


References:

1Beh SC, Masrour S, Smith SV, Friedman DI. The Spectrum of Vestibular Migraine: Clinical Features, Triggers, and Examination Findings. Headache. 2019 May;59(5):727-740. doi: 10.1111/head.13484. Epub 2019 Feb 8.

2Brodsky JR, Cusick BA, Zhou G. Evaluation and management of vestibular migraine in children: Experience from a pediatric vestibular clinic. Eur J Paediatr Neurol. 2016 Jan;20(1):85-92. doi: 10.1016/j.ejpn.2015.09.011. Epub 2015 Oct 22.

3Sohn JH. Recent Advances in the Understanding of Vestibular Migraine. Behav Neurol. 2016;2016:1801845. Epub 2016 Oct 16.

4Teggi R, Colombo B, Rocca MA, Bondi S, Messina R, Comi G, Filippi M. A review of recent literature on functional MRI and personal experience in two cases of definite vestibular migraine. Neurol Sci. 2016 Sep;37(9):1399-402. doi: 10.1007/s10072-016-2618-6. Epub 2016 May 25.

5Radtke A, von Brevern M, Neuhauser H, Hottenrott T, Lempert T. Vestibular migraine: long-term follow-up of clinical symptoms and vestibulo-cochlear findings. Neurology. 2012 Oct 9;79(15):1607-14. doi: 10.1212/WNL.0b013e31826e264f. Epub 2012 Sep 26.

6Tabet P, Saliba I. Meniere's Disease and Vestibular Migraine: Updates and Review of the Literature. J Clin Med Res. 2017;9(9):733–744. doi:10.14740/jocmr3126w

7Good PA, Taylor RH, Mortimer MJ. The use of tinted glasses in childhood migraine. Headache. 1991 Sep;31(8):533-6.

8Wilkins AJ, Wilkinson P. A tint to reduce eye-strain from fluorescent lighting? Preliminary observations. Ophthalmic Physiol Opt. 1991 Apr;11(2):172-5.

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