The impact of photophobia on daily light exposure in adolescents with migraine: a real-world study

The National Institute of Neurological Disorders and Stroke awarded The Children's Hospital of Philadelphia $708,565 on September 5, 2026, under the Extramural Research Programs in the Neurosciences and Neurological Disorders program (CFDA 93.853) to investigate the impact of photophobia on daily light exposure in adolescents with migraine.

The research will continuously track ambient light exposure and sleep during daily life in 75 adolescents aged 13 to 21 years with migraine-related photophobia and 75 age-, sex-, and time-of-year-matched migraine-free controls using wearable digital biosensors. The study will employ two biosensors: an ActLumus light dosimeter worn on the chest that measures high-spectral-resolution light including blue light that drives circadian photoentrainment, and a GeneActiv actigraphy wristwatch that measures sleep timing and quantity. Data collection will occur during two non-vacation 2-week periods within 2 months of the winter and summer solstice. The research tests the hypothesis that migraine-related photophobia causes maladaptive light avoidance, resulting in sleep disruption and worsened light intolerance over time.

Work is performed at Philadelphia, Pennsylvania. The period of performance extends through June 30, 2031.

Abstract

Photophobia (i.e., light sensitivity) is one of the most common and disabling symptoms associated with migraine that is present even in the absence of headache. Those with migraine report avoiding high-intensity visual environments, which is further encouraged by healthcare providers to reduce symptoms. However, IT is unknown whether light avoidance is adaptive or maladaptive. Light avoidance may reduce symptoms in the moment, but IT is unclear if IT also leads to physiologically relevant decreases in light exposure that negatively impact sleep and worsen light intolerance over time. This is particularly important for younger populations when lifelong habits are forming, and where early intervention may be more beneficial. To address this GAP, we will continuously track ambient light exposure and sleep during daily life in adolescents with and without migraine using wearable digital biosensors. We hypothesize that migraine-related photophobia causes maladaptive light avoidance, resulting in sleep disruption and worsened light intolerance. To test this hypothesis, we will continuously measure daily light exposure and sleep habits in 75 adolescents (13 - 21 years old) with migraine-related photophobia and 75 age-, SEX-, and time-of-year- matched migraine-free controls. We will utilize two biosensors to simultaneously collect light and sleep data: 1) the chest-worn actlumus light dosimeter that takes high spectral resolution measurements allowing US to isolate "blue" light that drives circadian photoentrainment, 2) geneactiv actigraphy wristwatch that produces reliable measurements related to sleep timing and quantity. Recordings will occur for two non-vacation 2-week periods within 2 months of the winter and summer solstice. We will determine if photophobia results in reduced daily light exposure by comparing adolescents with migraine-related photophobia to their migraine-free peers. Furthermore, we will determine if daily fluctuations in photophobia precede reductions in light exposure (aim 1). To evaluate if photophobia produces sleep disruption by reducing daily light exposure, we will compare sleep midpoint and total sleep time across groups and determine if daily reductions in light exposure predict delayed sleep time and shorter sleep durations (aim 2). Finally, we will determine if seasonal reductions in light exposure amplify the effects of migraine-related photophobia by comparing photophobia and light exposure near the winter and summer solstice in those with and without migraine (aim 3). Our combined expertise in pediatric headache, vision neuroscience, and sleep research place US in an ideal position to pursue this work. Regardless of the outcome, this project will provide fundamental measurements that will directly influence patient guidance on whether light avoidance is helpful or harmful. IT will also provide foundational measurements needed to design clinical trials that either prioritize graded light exposure (e.g. increasing time spent outdoors) or light avoidance (e.g. light blocking lens use).