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If a sunny day or the lights in your office building give you eye pain and a throbbing headache that sends you searching for the nearest dark room, you may have migraine.
“It’s extremely common for people to have light sensitivity and eye pain in migraine,” says Deborah Friedman, MD, MPH, a neuro-ophthalmologist and headache medicine specialist in Dallas, Texas. “Light sensitivity, known as photophobia, occurs more frequently than many other migraine symptoms, including nausea, vomiting, sensitivity to sound, or sensitivity to odor.
Here are answers to some common questions about light sensitivity and eye pain in migraine.
“Light sensitivity not only causes eye pain and aversion to light, it can make a headache worse,” says Dr. Friedman.
Even if it doesn’t occur first, the photophobia usually starts by the time headache pain begins, says Friedman. “For most people, light sensitivity and eye pain persist for the duration of the headache, and some people even have residual photophobia after the head pain ends,” she says.
It’s not uncommon for bright light or excessive light to bring on a migraine attack, says Friedman. “People will say that going out on a bright, sunny day or seeing the glare reflected off snow or water can sometimes trigger an attack,” she says.
It’s not clear why light sensitivity can become chronic, says Friedman. “There are people who get light sensitivity with migraine, and eventually they’re just more light-sensitive all the time,” she says.
“We do know that in the general population (not just those who have migraine), people with blue eyes or light-colored irises tend to be more light-sensitive,” she says.
Central sensitization is a condition of the central nervous system that can occur in people with chronic pain conditions. It happens when the system that mediates pain enters a persistent state of high reactivity. This lowers the threshold for pain, meaning it takes less and less of a stimulus to produce a response, explains Friedman.
“That’s the same thing we see in the visual system. Over time it takes less and less light to produce discomfort. Even with dimmed or less bright light, some people can experience the same response that they get with migraine,” she says.
“Unfortunately, there’s no magic pill that you can take that’s going to take your photophobia away. Most people who experience photophobia during a migraine attack go into a dark room,” says Friedman.
Medications used to treat acute attacks often work to treat the photophobia, because the symptom is part of the migraine process, she adds.
Ergotamine, a type of ergot alkaloid medication, is typically combined with caffeine to increase its effectiveness.
Ergot alkaloids are available as oral tablets, nasal sprays, rectal suppositories, and injections:
Common NSAIDs for migraine include the following:
Pain relievers such as naproxen, acetaminophen, and aspirin are also combined with other migraine medications and ingredients to increase their effectiveness and reduce side effects like nausea, vomiting, and sensitivity to light.
“When you try to come out into the light, it just gets harder and harder to do that. It creates a situation where a person almost has to become a hermit, because they can’t stand any light,” she says.
There has to be a balance between trying to reduce some of the ambient light, particularly blue wavelengths, and spending time in the dark, she adds.
Typically, for people who have been living in the dark, doctors will try to move them into the light gradually, says Friedman. “If someone is using glasses, we gradually lighten the tint while turning up the lights,” she says.
In addition to increasing your light tolerance and utilizing tools to minimize its negative impacts, it’s important to get your migraine attacks under control, says Friedman.
You should see a specialist if you have a lot of eye discomfort that doesn't just occur with exposure to light, such as itching, burning, tearing, redness, or a foreign body sensation (a feeling of something in your eye), says Friedman.
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