Intensity dependence of auditory evoked potentials during light interference in migraine

Migraine patients show interictally a strong intensity dependence of auditory evoked cortical potentials (IDAP) and a lack of habituation of evoked potentials. Photic drive on high-frequency flash stimulation is another well-known interictal feature in migraineurs, associated with alpha-rhythm hyper-synchronisation. We compared therefore the influence of light stimulation on IDAP in healthy volunteers (HV) and migraine patients. A continuous flash stimulation was delivered during the recording of auditory evoked potentials at suprathreshold increasing stimulation intensities. IDAP was measured as the amplitude/stimulus intensity function (ASF) slope. In HV, the ASF slope decreased during flash stimulation, whereas, on average, there was no significant change in migraineurs. A closer analysis of migraineurs disclosed two subgroups of patients with no detectable clinical differences: one, the largest, in which the ASF slope was normal at baseline, but increased during light stimulation, the other with an increased ASF slope at rest and a decrease during light interference. Visual sensory overload is able to increase IDAP in the majority of migraineurs, which contrasts with HV. We hypothesise that this could be due to hyper-synchronisation of the alpha rhythm because of photic drive and possibly thalamo-cortical dysfunction. A minority of migraineurs have, like HV, an IDAP reduction during light interference. They are, however, characterised, unlike most HV, by a high IDAP at baseline. Besides underscoring the pathophysiological heterogeneity of migraine, these results suggest that light interference might improve the phenotyping of migraine patients who have a normal IDAP in the resting condition.