The Influence of Photophobia on Postural Control in Patients With Migraine

Abstract

Background People with migraine exhibit postural control impairments. These patients also have an increased light sensitivity due to the disease, and it remains during the headache‐free period. It is currently unknown if increased lighting levels can alter the balance control, especially in individuals with visual hypersensitivity, such as migraineurs. This study aimed to assess the balance and photophobia of women with migraine and non‐headache controls under different light conditions. Methods This cross‐sectional study consisted of 14 women with migraine (mean ± SD 30.6 ± 8.1 years old) and 14 women without any kind of headache (mean ± SD 27.2 ± 2.8 years old) screened from a tertiary headache clinical hospital and the local community. Quiet standing balance was evaluated during bipodal and unipodal support, under 3 light conditions: ambient (AMB) – 270 lx, visual discomfort threshold (VDT) – 400 lx, and intense visual discomfort (IVD) – 2000 lx. Sway area of the center of pressure was processed and compared between groups. The association of migraine with the risk of presenting a greater imbalance in the discomfort lighting conditions was verified. Results Compared to the non‐headache controls, the migraine group presented greater sway area in bipodal stance under the 3 light conditions (mean difference (95% CI)): AMB 0.81 cm2 (0.19 to 1.43), P = .011; VDT 3.17 cm2 (0.74 to 5.60), P = .001; IVD 5.56 cm2 (2.75 to 8.37), P < .0001. Within‐subject analysis showed increased sway area in bipodal stance among all lighting conditions for the migraine group only (mean difference (95% CI)): VDT‐AMB 2.20 cm2 (0.23 to 4.18), P = .024; IVD‐AMB 4.50 cm2 (2.38 to 6.62), P < .0001, IVD‐VDT 2.29 cm2 (0.57 to 4.01), P = .005. The Prevalence Ratio (PR) analysis showed that migraine was associated with the risk of presenting greater imbalance in both bipodal and unipodal standing conditions for both VDT (PR value (95% CI) – bipodal: PR = 4.00 (1.02 to 15.59), P = .045; unipodal: PR = 4.00 (1.43 to 11.15), P = .008), and the IVD (bipodal: PR = 3.33 (1.13 to 9.58), P = .025; unipodal: PR = 5.50 (1.48 to 20.42), P = .010) lighting conditions. Conclusion Photophobia might be a disturbing factor that worsens the balance of patients with migraine during the quiet standing posture.

CGRP Administration Into the Cerebellum Evokes Light Aversion, Tactile Hypersensitivity, and Nociceptive Squint in Mice

“…However, we did not observe gait difference before or after PBS or CGRP treatment using the DigiGait system. A recent study reported that an increase in light intensity could enhance postural sway in migraine patients compared to controls ( 29 ), so perhaps additional triggers may be needed to detect such effects in mouse models. Overall, these data suggest that CGRP injection into the MN does not induce gait changes.…”

“…Strikingly, migraine patients exhibited decreased cerebellar activation in response to trigeminal nociceptive stimuli after treatment with erenumab, a CGRP receptor antibody ( 26 ). Second, migraine patients display cerebellar symptoms, e.g., dizziness, vertigo ( 27 ), body sway ( 28 ), as well as increased body sway accompanied by increased light intensity ( 29 ). Third, the cerebellum communicates directly to migraine-related regions, such as the spinal trigeminal nucleus ( 30 – 32 ) and the thalamus ( 33 ) via direct neural circuits.…”

CGRP Administration into the Cerebellum Evokes Migraine-like Behaviors Predominately in Female Mice

“…However, we did not observe gait difference before or after PBS or CGRP treatment using the DigiGait system. A recent study reported that an increase in light intensity could enhance postural sway in migraine patients compared to controls (54), so perhaps additional triggers may be needed to detect such effects in mouse models. Overall, these data suggest that CGRP injection into the MN does not induce gait changes.…”

“…Strikingly, migraine patients exhibited decreased cerebellar activation in response to trigeminal nociceptive stimuli after treatment with erenumab, a CGRP receptor antibody (50). Second, migraine patients display cerebellar symptoms, e.g., dizziness, vertigo (51), body sway (52,53), as well as increased body sway accompanied by increased light intensity (54). Third, the cerebellum communicates directly to migraine-related regions, such as the spinal trigeminal nucleus (55)(56)(57) and the thalamus (58) via direct neural circuits.…”

Stimulation of CGRP-expressing neurons in the medial cerebellar nucleus induces light and touch sensitivity in mice

“…It remains unclear whether this is due to secondary to a blockage of peripheral CGRP actions or central actions of the antibody ( Ziegeler et al, 2020 ). Second, vertigo, dizziness and body sway are symptoms observed in migraine patients ( Karatas, 2011 , Ishizaki et al, 2002 ), with body sway increasing at higher light intensities ( Pinheiro et al, 2020 ). This movement associated disequilibrium is suggestive of episodic cerebellar dysfunction in migraine patients as the cerebellum plays a key role in motor control.…”