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      Increased prevalence of depression and anxiety in patients with migraine and interictal photophobia

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          Abstract

          Background

          Most patients with migraine report photophobia associated with headache; a subset report interictal photophobia. These patients are light sensitive even during headache-free periods. The objective of this case–control study was to assess the prevalence of symptoms of anxiety and depression in migraine patients with and without interictal photophobia.

          Methods

          We recruited 16 subjects with migraine and interictal photophobia, 16 age- and gender-matched migraine subjects without interictal photophobia, and 16 age- and gender- matched controls. Migraine subjects met International Headache Society classification criteria. Participants completed a photophobia questionnaire, Beck Depression Inventory (BDI-II), and Beck Anxiety Inventory (BAI). Chi-square analyses and two-tailed Wilcoxon rank sum tests were used for the analyses.

          Results

          Subjects with interictal photophobia had significantly higher scores on the photophobia questionnaire compared to subjects without interictal photophobia. Subjects with interictal photophobia had significantly higher scores on the BDI-II and BAI compared to subjects without interictal photophobia.

          Conclusions

          Migraine patients with interictal photophobia are more likely to manifest symptoms of depression and anxiety compared to migraine patients without interictal photophobia. Care providers should be aware of increased prevalence of these symptoms in this population and consider appropriate referrals. Future research could assess whether treatment of photophobia leads to improvements in symptoms of depression and anxiety in migraine patients.

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          Most cited references35

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          The International Classification of Headache Disorders: 2nd edition.

          (2004)
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            A neural mechanism for exacerbation of headache by light

            The perception of migraine headache, which is mediated by nociceptive signals transmitted from the cranial dura mater to the brain, is uniquely exacerbated by exposure to light. Here we show that exacerbation of migraine headache by light is prevalent among blind persons who maintain non-image-forming photoregulation in the face of massive rod/cone degeneration. Using single-unit recording and neural tract-tracing in the rat, we identified dura-sensitive neurons in the posterior thalamus, whose activity was distinctly modulated by light, and whose axons projected extensively across layers I through V of somatosensory, visual and associative cortices. The cell bodies and dendrites of such dura/light-sensitive neurons were apposed by axons originating from retinal ganglion cells, predominantly from intrinsically-photosensitive retinal ganglion cells – the principle conduit of non-image-forming photoregulation. We propose that photoregulation of migraine headache is exerted by a non-image-forming retinal pathway that modulates the activity of dura-sensitive thalamocortical neurons.
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              Comorbidity of migraine and depression: investigating potential etiology and prognosis.

              An association between migraine and major depression has been observed in clinical and community samples. The factors that contribute to this association and their implications remain unclear. To determine the factors contributing to the association of migraine and major depression. A cohort study of persons aged 25 to 55 years with migraine (n = 496) or with other headaches of comparable severity (n = 151) and control subjects with no history of severe headaches (n = 539) randomly selected from the general community were interviewed first in 1997 and then reinterviewed in 1999. Major depression at baseline predicted the first-onset migraine during the 2-year follow-up period (odds ratio [OR] = 3.4; 95% CI = 1.4, 8.7) but not other severe headaches (OR = 0.6; 95% CI = 0.1, 4.6). Migraine at baseline predicted the first-onset major depression during follow-up (OR = 5.8; 95% CI = 2.7, 12.3); the prospective association from severe headaches to major depression was not significant (OR = 2.7; 95% CI = 0.9, 8.1). Comorbid major depression did not influence the frequency of migraine attacks, their persistence, or the progression of migraine-related disability over time. Major depression increased the risk for migraine, and migraine increased the risk for major depression. This bidirectional association, with each disorder increasing the risk for first onset of the other, was not observed in relation to other severe headaches. With respect to other severe headaches, there was no increased risk associated with pre-existing major depression, although the possibility of an influence in the reverse direction (i.e., from severe headaches to depression) cannot be securely ruled out.
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                Author and article information

                Contributors
                goodyllop@yahoo.com
                Jonathan.Frandsen@hci.utah.edu
                kathleen.digre@hsc.utah.edu
                Bradley.katz@hsc.utah.edu
                Alison.crum@hsc.utah.edu
                Chong.Zhang@hsc.utah.edu
                01-801-585-6653 , Judith.warner@hsc.utah.edu
                Journal
                J Headache Pain
                J Headache Pain
                The Journal of Headache and Pain
                Springer Milan (Milan )
                1129-2369
                1129-2377
                14 April 2016
                14 April 2016
                2016
                : 17
                : 34
                Affiliations
                [ ]Department of Ophthalmology, University of Puerto Rico School of Medicine, PO Box 365067, San Juan, Puerto Rico 00936 USA
                [ ]Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah Health Sciences Center, 65 N. Mario Capecchi Drive, Salt Lake City, UT 84132 USA
                [ ]Department of Neurology, University of Utah Health Sciences Center, 175 North Medical Drive East, Salt Lake City, UT 84132 USA
                [ ]Division of Epidemiology, Department of Internal Medicine, University of Utah Health Sciences Center, 30 N 1900 East, Salt Lake City, UT 84132 USA
                Article
                629
                10.1186/s10194-016-0629-6
                4831954
                27080113
                1aee7d3d-7a30-4951-a6be-7747521b8460
                © Llop et al. 2016

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

                History
                : 16 January 2016
                : 7 April 2016
                Funding
                Funded by: Research to Prevent Blindness, Inc.
                Funded by: National Heart, Lung, and Blood Institute (US)
                Award ID: T35 HL007744
                Award Recipient :
                Funded by: FundRef http://dx.doi.org/10.13039/100000050, National Heart, Lung, and Blood Institute;
                Award ID: T35 HL007744
                Award Recipient :
                Funded by: National Center for Research Resources, (US)
                Award ID: 5UL1TR001067-02
                Award Recipient :
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2016

                Anesthesiology & Pain management
                photophobia,migraine,depression,anxiety,sleep disorders,intrinsically photosensitive retinal ganglion cells

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