Department of Psychology, University of Essex, UK.
Department of Psychology and Integrative Neuroscience, University of Nevada, Reno, USA.
Cephalalgia. 2021 Oct;41(11-12):1240-1248. doi: 10.1177/03331024211014633. Epub 2021 May 14.
Photophobia is one of the most common symptoms in migraine, and the underlying mechanism is uncertain. The discovery of the intrinsically-photosensitive retinal ganglion cells which signal the intensity of light on the retina has led to discussion of their role in the pathogenesis of photophobia. In the current review, we discuss the relationship between pain and discomfort leading to light aversion (traditional photophobia) and discomfort from flicker, patterns, and colour that are also common in migraine and cannot be explained solely by the activity of intrinsically-photosensitive retinal ganglion cells. We argue that, at least in migraine, a cortical mechanism provides a parsimonious explanation for discomfort from all forms of visual stimulation, and that the traditional definition of photophobia as pain in response to light may be too restrictive. Future investigation that directly compares the retinal and cortical contributions to photophobia in migraine with that in other conditions may offer better specificity in identifying biomarkers and possible mechanisms to target for treatment.
畏光症是偏头痛最常见的症状之一，其潜在机制尚不清楚。对内在感光视网膜神经节细胞的发现，这些细胞在视网膜上对光的强度发出信号，这促使人们对其在畏光症发病机制中的作用展开了讨论。在目前的综述中，我们讨论了导致对光厌恶（传统畏光症）的疼痛和不适与也常见于偏头痛的闪烁、图案和颜色不适之间的关系，而这些不适不能仅用内在感光视网膜神经节细胞的活动来解释。我们认为，至少在偏头痛中，皮质机制为各种形式的视觉刺激引起的不适提供了一种简洁的解释，而将畏光症定义为对光的疼痛可能过于局限。未来的研究直接比较偏头痛中与其他疾病中视网膜和皮质对畏光症的贡献，可能会更好地识别生物标志物，并确定可能的治疗靶点。
