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Lights out

By Timothy Cocks Science and the world 20 Feb 2014

Why Light Hurts During Migraines

Researchers believe they know why light exacerbates the already debilitating pain of migraines, even in some blind people.

A report published online Jan. 10 in Nature Neuroscience reveals how visual and pain pathways in the brain converge to produce this phenomenon.

The Boston-based researchers report there are cells in a part of the brain called the thalamus “where information from the visual system and information from the pain system converge, and that anatomic convergence provides the first available explanation for how it could be that light makes pain worse,” added Dr. Richard Lipton, director of the Montefiore Headache Center and professor of neurology and epidemiology at Albert Einstein College of Medicine in New York City.

About 85% to 90% of all migraine sufferers report having photophobia, which is when light makes the pain worse, said study senior author Rami Burstein, an associate professor of anesthesia and neuroscience at Beth Israel Deaconess Medical Center and Harvard Medical School in Boston.

“We had no clue in the world where in the world light and pain talk to each other in the brain,” Burstein said. “They have completely different pathways in the brain.”

“For light to make pain, those pathways would have to converge at some level,” Lipton noted.

To solve the paradox, the team studied 20 blind individuals, all of whom suffered from migraines. Six participants had no light perception at all and no functioning optic nerve. These individuals also experienced no photophobia.

The remaining 14 people could sense light and dark and also experienced photophobia.

“This told us that the optic nerve is critically needed in order to produce photophobia or exacerbation of the headache by light,” Burstein explained.

The researchers next discovered that a set of photoreceptors called melanopsin project onto neurons on the thalamus that also process pain signals.

Some issues with “pain pathways” and “pain signals” but worth it for this:

The findings should put to rest any thoughts that patients exaggerate their sensitivity to light, Lipton said. “This provides an anatomic and physiological basis for a common experience — that light makes pain worse, not because you’re a whiner, but because there is an anatomic pathway that links the visual system to the pathway that produces head pain,” Lipton said. “That odd bit of clinical symptomatology has a firm basis in brain science.” (emphasis added)

I’m reminded of Vilayanur Ramachandran, who in an interview I once saw said something along the lines of ‘instead of dismissing these people (reporting phantom limb sensations) as crazy, I went looking for an answer in the brain’.

Are there any “odd bits of clinical symptomatology” out there that are still dismissed?

-Tim Cocks

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  1. Having suffered severe migraines since the age of six I can sympathise with my fellow sufferers and identify with photophobia in addition to a long list of migraine attack stimulants, both physical and emotional. Indeed, over the years the smell of peanut butter was added to the list as a “Trigger” for an attack ! But we know that the brain will recruit any incoming information to “Smell” what is going on in its own body over time. The patient that experiences more pain when it’s cold for example. So what’s the mystery here ?

    1. timcocks0noi

      Perhaps the only mystery is why its taken some people (those with only 3rd person data, not 1st person experience) so long to catch on?

  2. This takes us back to the art of listening to the patient and actually hearing what they say. Good old Geoff ….

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