Photophobia Contributes to Migraine-Associated Disability and Reduced Work Productivity: Results From the American Registry for Migraine Research (ARMR)
Authors: Leibovit-Reiben Zachary , Dumkrieger Gina , Dodick David W. , Digre Kathleen , Chong Catherine D. , Trivedi Meesha , Schwedt Todd J. 
Published: August 2023

Background:
Photosensitivity, often called “photophobia” in the migraine literature, is a common and bothersome symptom for most people during their migraine attacks. This study aimed to investigate the association of photophobia severity with work productivity, activity impairment, and migraine-associated disability using data from a large cohort of patients with migraine who were enrolled into the American Registry for Migraine Research (ARMR).

Methods:
This study used Photosensitivity Assessment Questionnaire (PAQ) scores to investigate the relationship between photophobia severity with work productivity and activity impairment (using the Work Productivity and Activity Impairment [WPAI] questionnaire) and migraine-related disability (using the Migraine Disability Assessment [MIDAS]) among those with migraine. Summary statistics are presented as means and standard deviations for variables that were normally distributed and as medians and interquartile ranges for variables that were not normally distributed. Multiple linear regression models were developed to measure the relationships between photophobia scores with work productivity and activity impairment and migraine-associated disability, controlling for age, sex, headache frequency, headache intensity, anxiety (using the generalized anxiety disorder [GAD-7]), and depression (using the Patient Health Questionnaire [PHQ-2]).

Results:
One thousand eighty-four participants were included. Average age was 46.1 (SD 13.8) years, 87.2% (n = 945) were female, average headache frequency during the previous 90 days was 44.3 (SD 29.9), average headache intensity was 5.9 (SD 1.7), median PHQ-2 score was 1 (IQR 0–2), and median GAD-7 was 5 (IQR 2–8). Mean PAQ score was 0.47 (SD 0.32), and median MIDAS score was 38 (IQR 15.0–80.0). Among the 584 employed participants, 47.4% (n = 277) reported missing work in the past week because of migraine, mean overall work impairment was 42.8% (SD 26.7), mean activity impairment was 42.5% (SD 26.2), mean presenteeism score was 38.4% (SD 24.4), and median absenteeism was 0 (IQR 0–14.5). After controlling for age, sex, headache frequency, average headache intensity, PHQ-2 score, and GAD-7 score, there was a statistically significant association between photophobia scores with: a) MIDAS scores (F[7,1028] = 127.42, P < 0.001, R2 = 0.461, n = 1,036); b) overall work impairment (F[7,570] = 29.23, P < 0.001, R2 = 0.255, n = 578); c) activity impairment (F[7,570] = 27.42, P < 0.001, R2 = 0.243, n = 578); d) presenteeism (F[7,570] = 29.17, P < 0.001, R2 = 0.255, n = 578); and e) absenteeism for the zero-inflated (P = 0.003) and negative binomial (P = 0.045) model components (P < 0.001, n = 578).

Conclusions:
In those with migraine, severe photophobia is associated with reduced work productivity and higher presenteeism, absenteeism, activity impairment, and migraine-related disability.