Photophobia Contributes to Migraine-Associated Disability and Reduced Work Productivity: Results From the American Registry for Migraine Research (ARMR)

Profiling chronic migraine patients according to clinical characteristics: a cluster analysis approach

Background

To group the characteristics of chronic migraine (CM) by headache characteristics.

Methods

We performed a retrospective analysis of the medical records of 821 adult CM patients who visited a specialized outpatient clinic for headaches. Using the headache characteristics, we performed Density-Based Spatial Clustering of Applications with Noise (DBSCAN) clustering to group CM patients. The burdens to their lives, monthly headache days (MHD), monthly acute medication intake days (AMD), and treatment outcomes were evaluated among the clusters.

Results

Through a cluster analysis based on headache characteristics, our findings indicated the potential existence of three distinct types of CM: cluster 1 (predominantly female with CM resembling migraine), cluster 2 (higher age, higher BMI, smoker), and cluster 3 (mostly female with CM that have fewer migraine characteristics). The impact on quality of life was significant in cluster 1 compared to cluster 3. However, there were no differences in treatment outcomes, initial MHD, AMD, the years of migraine, or treatment sensitivity among these three clusters.

Conclusion

Cluster analysis mathematically divided CM patients into three groups, with predominant differences in the degree of disruption to their lives and their characteristics; further research is needed on the diagnostic criteria for CM and its characteristics.

Photophobia is associated with lower sleep quality in individuals with migraine: results from the American Registry for Migraine Research (ARMR)

BACKGROUND

Patients with migraine often have poor sleep quality between and during migraine attacks. Furthermore, extensive research has identified photophobia as the most common and most bothersome symptom in individuals with migraine, second only to headache. Seeking the comfort of darkness is a common strategy for managing pain during an attack and preventing its recurrence between episodes. Given the well-established effects of daily light exposure on circadian activity rhythms and sleep quality, this study aimed to investigate the relationship between photophobia symptoms and sleep quality in a cohort of patients with migraine.

METHODS

A cross-sectional observational study was conducted using existing data extracted from the American Registry for Migraine Research (ARMR). Participants with a migraine diagnosis who had completed the baseline questionnaires (Photosensitivity Assessment Questionnaire (PAQ), Generalized Anxiety Disorder-7 (GAD-7), Patient Health Questionnaire-2 (PHQ-2)), and selected questions of the ARMR Sleep questionnaire were included. Models were created to describe the relationship of photophobia and photophilia with various sleep facets, including sleep quality (SQ), sleep disturbance (SDis), sleep onset latency (SOL), sleep-related impairments (SRI), and insomnia. Each model was controlled for age, sex, headache frequency, anxiety, and depression.

RESULTS

A total of 852 patients meeting the inclusion criteria were included in the analysis (mean age (SD) = 49.8 (13.9), 86.6% (n = 738) female). Those with photophobia exhibited significantly poorer sleep quality compared to patients without photophobia (p < 0.001). Photophobia scores were associated with SQ (p < 0.001), SDis (p < 0.001), SOL (p = 0.011), SRI (p = 0.020), and insomnia (p = 0.005) after controlling for age, sex, headache frequency, depression, and anxiety, signifying that higher levels of photophobia were associated with worse sleep-related outcomes. Conversely, photophilia scores were associated with better sleep-related outcomes for SQ (p < 0.007), SOL (p = 0.010), and insomnia (p = 0.014).

CONCLUSION

Results suggest that photophobia is a significant predictor of poor sleep quality and sleep disturbances in migraine. These results underscore the necessity for comprehensive and systematic investigations into the intricate interplay between photophobia and sleep to enhance our understanding and develop tailored solutions for individuals with migraine.