Washington University School of Medicine in St. Louis, St. Louis, MO, USA.
Department of Neurology, Mayo Clinic, Phoenix, AZ, USA.
Headache. 2020 Mar;60(3):506-514. doi: 10.1111/head.13745. Epub 2020 Jan 22.
Migraine with aura (MwA) is associated with increased brain hyper-responsiveness to visual stimuli and increased visual network connectivity relative to migraine without aura (MwoA). Despite this, prior studies have provided conflicting results regarding whether MwA is associated with higher photophobia symptom scores compared to MwoA. The relationships between MwA and other types of sensory hypersensitivity, such as phonophobia and cutaneous allodynia (CA), have not been previously investigated. The purpose of this cross-sectional observational study was to investigate whether MwA is associated with greater symptoms of photophobia, phonophobia, and CA compared to MwoA.
This analysis included 321 migraine patients (146 MwA; 175 MwoA) who had been enrolled into the American Registry for Migraine Research. The diagnosis of either MwoA or MwA was determined by headache specialists using ICHD diagnostic criteria. Patients completed the Photosensitivity Assessment Questionnaire, the Hyperacusis Questionnaire, and the Allodynia Symptom Checklist. Mean or median values were compared between groups. Regression models were created to analyze the relationship between MwA with photophobia scores, hyperacusis scores, and the presence of interictal CA.
Those with MwA had higher mean photophobia scores than those with MwoA (4.1 vs 3.0, P = .0003). MwA was positively associated with photophobia symptom severity (B = 0.50 [SE = 0.14], P = .0003), after controlling for age, patient sex, and headache frequency. Aura was not associated with hyperacusis symptom severity (B = 0.07 [SE = 0.08], P = .346) or the presence of interictal CA (OR 1.33 [95% CI 0.70-2.53], P = .381).
MwA is associated with higher photophobia symptom scores compared to MwoA. Aura is not associated with greater hyperacusis or interictal allodynia scores. These findings complement prior imaging and neurophysiologic studies that demonstrated MwA to be associated with hyper-responsiveness of brain visual processing regions. The findings suggest that MwA is associated specifically with visual hypersensitivity, as opposed to being associated with a general hypersensitivity to multiple types of sensory stimuli.
有先兆偏头痛（MwA）与视觉刺激引起的大脑过度反应以及视觉网络连接性增加有关，而无先兆偏头痛（MwoA）则无此现象。尽管如此，先前的研究对于 MwA 是否与更高的畏光症状评分有关存在矛盾。MwA 与其他类型的感觉过敏（如恐声症和皮肤痛觉过敏）之间的关系尚未被研究。本横断面观察性研究的目的是探讨与 MwoA 相比，MwA 是否与更严重的畏光、恐声和皮肤痛觉过敏症状有关。
该分析纳入了 321 名偏头痛患者（146 名 MwA；175 名 MwoA），他们已被纳入美国偏头痛研究登记处。头痛专家根据 ICHD 诊断标准确定 MwoA 或 MwA 的诊断。患者完成了光敏感评估问卷、听觉过敏问卷和感觉过敏症状检查表。对组间的均值或中位数进行比较。创建回归模型以分析 MwA 与畏光评分、听觉过敏评分和发作间期皮肤痛觉过敏的关系。
与 MwoA 相比，MwA 患者的平均畏光评分更高（4.1 对 3.0，P =.0003）。在控制年龄、患者性别和头痛频率后，MwA 与畏光症状严重程度呈正相关（B = 0.50 [SE = 0.14]，P =.0003）。先兆与听觉过敏症状严重程度（B = 0.07 [SE = 0.08]，P =.346）或发作间期皮肤痛觉过敏的存在（OR 1.33 [95% CI 0.70-2.53]，P =.381）无关。
与 MwoA 相比，MwA 与更高的畏光症状评分有关。先兆与更大的听觉过敏或发作间期皮肤痛觉过敏评分无关。这些发现补充了先前的影像学和神经生理学研究，表明 MwA 与大脑视觉处理区域的过度反应有关。这些发现表明，MwA 与视觉过敏有关，而不是与对多种类型的感觉刺激的一般过敏有关。
