Unilateral increased visual sensitivity in cluster headache: a cross-sectional study

Abstract

Background and Objectives Increased sensitivity to light and patterns is typically associated with migraine, but has also been anecdotally reported in cluster headache, leading to diagnostic confusion. We wanted to assess whether visual sensitivity is increased ictally and interictally in cluster headache. Methods We used the validated Leiden Visual Sensitivity Scale (L-VISS) questionnaire (range 0-36 points) to measure visual sensitivity in people with episodic or chronic cluster headache: (i) during attacks; (ii) in-between attacks; and in episodic cluster headache (iii) in-between bouts. The L-VISS scores were compared with the L-VISS scores obtained in a previous study in healthy controls and participants with migraine. Results Mean L-VISS scores were higher for: (i) ictal vs interictal cluster headache (episodic cluster headache: 11.9 ± 8.0 vs. 5.2 ± 5.5, chronic cluster headache: 13.7 ± 8.4 vs 5.6 ± 4.8; p < 0.001); (ii) interictal cluster headache vs controls (5.3 ± 5.2 vs 3.6 ± 2.8, p < 0.001); (iii) interictal chronic cluster headache vs interictal ECH in bout (5.9 ± 0.5 vs 3.8 ± 0.5, p = 0.009), and (iv) interictal episodic cluster headache in bout vs episodic cluster headache out-of-bout (5.2 ± 5.5 vs. 3.7 ± 4.3, p < 0.001). Subjective visual hypersensitivity was reported by 110/121 (91%; 9 missing) participants with cluster headache and was mostly unilateral in 70/110 (64%) and ipsilateral to the ictal pain in 69/70 (99%) participants. Conclusion Cluster headache is associated with increased ictal and interictal visual sensitivity. In contrast to migraine, this is mostly unilateral and ipsilateral on the side of the ictal pain.

Approach to the Patient With Headache

“…Preventive migraine treatment benefits patients experiencing interictal burden. 34,38 For more information, refer to the article "Preventive Treatment of Migraine" by Richard B. Lipton, MD, FAAN, 42 in this issue of Continuum.…”

“…Furthermore, migraine affects work, career, daily activities, relationships, and even the decision to have children. Preventive migraine treatment benefits patients experiencing interictal burden 34,38 . For more information, refer to the article “Preventive Treatment of Migraine” by Richard B. Lipton, MD, FAAN, 42 in this issue of Continuum .…”

“…Although we tend to concentrate on headache attacks when taking a history, symptoms can persist into the interictal phase, particularly in migraine, tension-type headache, and cluster headache. 37,38 Several lines of evidence document that patients with episodic and chronic migraine have a poorer quality of life in between episodes compared with those without migraine. 37 Functional imaging studies corroborate changes in the brain during this interictal phase.…”

Debate: Are cluster headache and migraine distinct headache disorders?

“…Visual allodynia defined as enhanced sensitivity to light and patterns was recently investigated in CH. Interestingly, CH patients mostly report unilateral visual allodynia that is ipsilateral to the side of the ictal pain [53,54]. Cutaneous allodynia is a common feature Fig.…”

“…Visual allodynia defined as enhanced sensitivity to light and patterns was recently investigated in CH. Interestingly, CH patients mostly report unilateral visual allodynia that is ipsilateral to the side of the ictal pain [ 53 , 54 ]. Cutaneous allodynia is a common feature accompanying migraine attacks [ 55 ] and is considered a clinical marker of central sensitization [ 38 ], and a risk factor for migraine chronification [ 38 ] but not associated with chronic CH [ 41 ].…”