graph LR
Parasympathetic_Generalization["Parasympathetic Generalization"]
Nasal_Prickling_Sensation["Nasal Prickling Sensation"]
Light_Triggered_Sneezing["Light-Triggered Sneezing"]
Enhanced_Visual_and_Somatosensory_Cortical_Responses["Enhanced Visual and Somatosensory Cortical Responses"]
Optic_Trigeminal_Cross_Activation["Optic-Trigeminal Cross-Activation"]
General_Sneeze_Execution_Circuit["General Sneeze Execution Circuit"]
Abrupt_Bright_Light_Stimulation["Abrupt Bright-Light Stimulation"]
Abrupt_Bright_Light_Stimulation --> Enhanced_Visual_and_Somatosensory_Cortical_Responses
Abrupt_Bright_Light_Stimulation --> Optic_Trigeminal_Cross_Activation
Abrupt_Bright_Light_Stimulation --> Parasympathetic_Generalization
Enhanced_Visual_and_Somatosensory_Cortical_Responses --> Nasal_Prickling_Sensation
Enhanced_Visual_and_Somatosensory_Cortical_Responses --> General_Sneeze_Execution_Circuit
Optic_Trigeminal_Cross_Activation --> General_Sneeze_Execution_Circuit
Parasympathetic_Generalization --> General_Sneeze_Execution_Circuit
General_Sneeze_Execution_Circuit --> Light_Triggered_Sneezing
style Parasympathetic_Generalization fill:#dbeafe
style Nasal_Prickling_Sensation fill:#fef3c7
style Light_Triggered_Sneezing fill:#fef3c7
style Enhanced_Visual_and_Somatosensory_Cortical_Responses fill:#dbeafe
style Optic_Trigeminal_Cross_Activation fill:#dbeafe
style General_Sneeze_Execution_Circuit fill:#dbeafe
style Abrupt_Bright_Light_Stimulation fill:#dbeafe
graph LR
Ditans_Lasmiditan["Ditans (Lasmiditan)"]
CGRP_Pathway["CGRP Pathway"]
Trigeminovascular_Activation["Trigeminovascular Activation"]
Vestibulo_Thalamo_Cortical_Dysfunction["Vestibulo-Thalamo-Cortical Dysfunction"]
Vestibular_CGRP_Signaling["Vestibular CGRP Signaling"]
PACAP_Pathway["PACAP Pathway"]
Vestibulo_Cerebellar_Integration_Failure_and_Compensation["Vestibulo-Cerebellar Integration Failure and Compensation"]
Dietary_Triggers["Dietary Triggers"]
Anti_PACAP_Ligand_Monoclonal_Antibody["Anti-PACAP Ligand Monoclonal Antibody"]
Trigemino_Vestibular_Pathway["Trigemino-Vestibular Pathway"]
Headache["Headache"]
Vertigo["Vertigo"]
Cortical_Spreading_Depression["Cortical Spreading Depression"]
Central_Sensitization["Central Sensitization"]
Cortical_Spreading_Depression --> Trigeminovascular_Activation
Trigeminovascular_Activation --> PACAP_Pathway
Trigeminovascular_Activation --> CGRP_Pathway
Trigeminovascular_Activation --> Trigemino_Vestibular_Pathway
CGRP_Pathway --> Central_Sensitization
CGRP_Pathway --> Vestibular_CGRP_Signaling
Trigemino_Vestibular_Pathway --> Vestibulo_Thalamo_Cortical_Dysfunction
Vestibulo_Thalamo_Cortical_Dysfunction --> Vertigo
Vestibulo_Cerebellar_Integration_Failure_and_Compensation --> Vertigo
Vestibular_CGRP_Signaling --> Trigemino_Vestibular_Pathway
PACAP_Pathway --> Central_Sensitization
Dietary_Triggers --> Headache
Ditans_Lasmiditan --> Trigeminovascular_Activation
Anti_PACAP_Ligand_Monoclonal_Antibody --> PACAP_Pathway
style Ditans_Lasmiditan fill:#fce7f3
style CGRP_Pathway fill:#dbeafe
style Trigeminovascular_Activation fill:#dbeafe
style Vestibulo_Thalamo_Cortical_Dysfunction fill:#dbeafe
style Vestibular_CGRP_Signaling fill:#dbeafe
style PACAP_Pathway fill:#dbeafe
style Vestibulo_Cerebellar_Integration_Failure_and_Compensation fill:#dbeafe
style Dietary_Triggers fill:#dcfce7
style Anti_PACAP_Ligand_Monoclonal_Antibody fill:#fce7f3
style Trigemino_Vestibular_Pathway fill:#dbeafe
style Headache fill:#fef3c7
style Vertigo fill:#fef3c7
style Cortical_Spreading_Depression fill:#dbeafe
style Central_Sensitization fill:#dbeafe
name: com_Achoo_Syndrome__Migraine
creation_date: "2026-07-31T10:39:09Z"
curation_status: CURATED
notes: >-
Structured from a prose association previously recorded only in
`Achoo_Syndrome.yaml`'s free-text `notes:` (see dismech#7263). A single
Japanese web-based cross-sectional cohort (n=11,840) found photic sneeze
syndrome (PSS) associated with migraine (OR=1.97) and with psychological
distress (K6>=5: OR=1.40; K6>=13: OR=1.49). Migraine is modeled here as the
comorbidity; the psychological-distress finding from the same study is
recorded in this entry's notes rather than as a second MONDO-anchored
comorbidity, since psychological distress (assessed via the Kessler K6
scale) is a symptom-scale construct rather than a discrete disease entity.
Directionality is UNKNOWN: the study is cross-sectional self-report and
cannot establish which condition (if either) precedes the other. This is a
single-cohort finding, not yet replicated - treat the effect sizes as
preliminary.
disease_a:
slug: Achoo_Syndrome
preferred_term: Achoo syndrome
term:
id: MONDO:0007038
label: Achoo syndrome
disease_b:
slug: Migraine
preferred_term: migraine
term:
id: MONDO:0005277
label: migraine disorder
directionality: UNKNOWN
effect_direction: RISK
hypotheses:
- description: >-
Hypothesis: shared trigeminal nerve hypersensitivity links photic sneeze
syndrome (PSS) and migraine. PSS has been proposed to arise via
optic-trigeminal summation, in which light-evoked activity in the optic
pathways cross-activates the trigeminal nerve; trigeminal nerve
hypersensitivity is also implicated in migraine and in the photophobia
that commonly accompanies it. The authors hypothesize that trigeminal
hypersensitivity in PSS confers susceptibility to migraine, but the
cross-sectional design does not establish this mechanism directly.
evidence:
- reference: PMID:31287245
reference_title: "Possible association between photic sneeze syndrome and migraine and psychological distress."
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: >-
Given the commonalities in the mechanisms underlying PSS, photophobia,
and migraine, we hypothesized that hypersensitivity of the trigeminal
system in individuals with PSS could confer susceptibility to migraine.
explanation: >-
States the trigeminal-hypersensitivity hypothesis motivating the
study's test of a PSS-migraine association.
association_signals:
- source: LITERATURE
method: LITERATURE_ASSOCIATION
population: >-
Japanese web-based questionnaire cohort (Health Data Lab / Yahoo! Japan
Corporation), self-reported photic sneeze syndrome and migraine, n=11,840.
directionality: UNKNOWN
effect_direction: RISK
statistics:
metrics:
- metric_type: OR
metric_value: 1.97
metric_ci_lower: 1.57
metric_ci_upper: 2.48
p_value: 2.18e-9
notes: >-
Odds of self-reported migraine among individuals with photic sneeze
syndrome vs. those without, unadjusted, cross-sectional.
evidence:
- reference: PMID:31287245
reference_title: "Possible association between photic sneeze syndrome and migraine and psychological distress."
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: "likely to suffer from migraine (odds ratio = 1.97, P = 2.18 × 10-9 )"
explanation: >-
Primary quantitative result establishing the PSS-migraine
association, with the effect size flagged in dismech#7263 as needing
snippet verification against the abstract before curation.
notes: >-
Same cohort and paper also report PSS associated with clinically relevant
psychological distress (K6>=5: OR=1.40, 95% CI 1.14-2.72, P=0.00143) and
severe psychological distress (K6>=13: OR=1.49, 95% CI 1.00-2.23,
P=0.0486). Both intervals are reproduced as printed in the source; note the
K6>=5 interval is not symmetric about its point estimate. These two odds
ratios are unadjusted. The separate finding that the PSS-distress
relationship holds irrespective of migraine status comes not from these
ORs but from a two-way/three-way factorial ANOVA on continuous K6 scores,
in which PSS and migraine were independently associated with higher K6 and
their interaction term was non-significant. Not modeled as a separate
comorbidity here (see entry-level notes).