Headache

11 January 2010

Why light hurts during migraines

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

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

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

Although the findings are unlikely to help migraine patients in the near future, "this gives us a little better insight as to the theory and mechanism behind migraine," said Dr Michael Palm, an assistant professor of neuroscience and experimental therapeutics and internal medicine at Texas A&M Health Science Centre College of Medicine, College Station, and director of the Parkinson's and Headache programmes at Texas Brain and Spine Institute in Bryan.

"We are making progress in understanding this phenomenon," he said.

What lead to the study

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 Centre 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, a professor of anaesthesia and neuroscience at Beth Israel Deaconess Medical Centre 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.

How the study was done

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.

"If we wanted to understand how light makes the pain worse, we needed to follow in the brain the pathways that lead from the eye into the brain using the third group of photoreceptors," Burstein said. "That is the connection so at that point we shifted to animals."


What the researchers found

The thalamus is the brain's sensory switchboard, receiving sensory signals from different parts of the body then redirecting them to various sensory, motor and cognitive areas of the cortex.

"We identified a new pathway in the brain that originates in the eye and goes to the brain areas where neurons are found that are active during migraine attacks," Burstein said. "The light can increase the electrical activity in neurons that are active to begin with."

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." - (HealthDay News, January 2010)

 

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Headache expert

Dr Elliot Shevel is a South African migraine surgery pioneer and the founder and medical director of The Headache Clinic in Johannesburg, Durban and Cape Town, South Africa. The Headache Clinic is a multidisciplinary practice dedicated to the diagnosis and treatment of Primary Headaches and Migraines. Dr Shevel is also the main author of all scientific publications generated by his team. He recently won a high level science debate in which he was able to prove that the current migraine diagnosis and classification is not based on data. Tertiary Education - Dr Shevel holds both Dental and Medical degrees, and practises as a specialist Maxillo-facial and Oral Surgeon. Follow the Headache Clinic on Twitter@HeadacheClinic.

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