Interictal avoidance of sensory stimuli among individuals with migraine

To examine differences in interictal avoidance of light and sound stimuli and to explore the moderating effect of psychological variables on behavioral avoidance.

The behavioral effects of migraine between attacks have become of recent interest, and a growing body of literature attests to the role of psychological factors such as fear of pain in influencing interictal behavior. Though light and sound sensitivity are common features of migraine attacks, it is unknown whether avoidance of these stimuli manifests outside of acute attacks. Such findings would inform our understanding of interictal disability and the potential role of psychological factors in migraine-related avoidance.

This was a within-between subjects, comparative cross-sectional study among 32 participants with migraine (28 photophobia and phonophobia, three photophobia only, one phonophobia only), each with photophobia and/or phonophobia, and 23 controls denying headache. While headache-free, participants were administered a series of self-report measures and completed behavioral avoidance tasks (BATs) quantifying approach and tolerance of three light stimuli and three sound stimuli representing increasing stimulus intensities. Data were collected from a Southern US university from November 2019 to December 2022. Analyses focused on differences between and within groups across the BATs and whether psychological variables moderated observed effects for those with migraine.

Individuals with migraine engaged in greater avoidance of the highest intensity light stimuli on both the approach task (mean = 101.5 in. vs. 117.8, p = 0.003, 95% confidence interval [CI] of difference: 5.8 to 26.8) and tolerance task (mean = 59.4 s vs. 92.5, p = 0.006, 95% CI of difference: 9.8 to 56.3). Task-by-group interactions were observed such that those with migraine engaged in greater behavioral avoidance than controls moving from low to high intensity on approach tasks (estimate = -16.9 in., p = 0.012, 95% CI: -30.0 to -3.7) and tolerance tasks (estimate = -31.0 s, p = 0.004, 95% CI: -51.9 to -10.0). No between-group differences or interactions were observed for the sound BATs. Among psychological variables, fear of pain and headache acceptance showed some associations with behavioral avoidance across various conditions and task intensities.

This study provides empirical evidence of interictal avoidance of light stimuli among those with migraine and suggests psychological variables play a role in avoidance that manifests outside of migraine attacks. These findings among young, non-treatment-seeking adults primarily with episodic migraine suggest that interictal behavioral avoidance manifests early in migraine progression. Further research exploring mechanisms and predictors of interictal avoidance, potential intervention targets, and manifestations in older adults and clinical samples is warranted.