Measurement of visual sensitivity in migraine: Validation of two scales and correlation with visual cortex activation

Abstract

Objective The objectives of this article are to compare interictal and ictal visual sensitivity between migraine and controls using two published questionnaires, and to correlate responses with a physiologic measure of visual cortex activation. Methods Migraine with (MWA, n = 51) and without (MwoA, n = 45) aura and control individuals ( n = 45) were enrolled and underwent BOLD fMRI with a visual stimulus. The visual discomfort score (VDS) assessed interictal and the migraine photophobia score (MPS) assessed ictal visual sensitivity. Result VDS was significantly higher both in MWA and MwoA vs controls (both p < 0.0001). MPS was greater in MWA vs MwoA ( p = 0.008). Ictal and interictal visual sensitivity strongly correlated in MWA ( p = 0.004) but not MwoA patients ( p = 0.12). BOLD activation in visual cortex was greater in MWA vs controls (2.7% vs 2.3%, p = 0.003) but similar between MwoA and controls. Increasing VDS was associated with greater BOLD signal change in MWA ( p = 0.03) but not MwoA ( p = 0.65) or controls ( p = 0.53). MPS did not correlate with BOLD activation in either group. Conclusion Increased interictal visual sensitivity is present both in MWA and MwoA. However, the correlation with ictal visual sensitivity and with cortical hyper-responsivity varies between MWA and MwoA, suggesting underlying differences between groups.