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, R 2 = 0.461, n = 1,036); b) overall work impairment (F[7,570] = 29.23, P < 0.001, R 2 = 0.255, n = 578); c) activity impairment (F[7,570] = 27.42, P < 0.001, R 2 = 0.243, n = 578); d) presenteeism (F[7,570] = 29.17, P < 0.001, R 2 = 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., Competing Interests: Z. Leibovit-Reiben reports no conflicts of interest. G. Dumkrieger has received research funding from Amgen. D. W. Dodick reports the following conflicts within the past 12 months: Consulting: Amgen, Allergan, Abbvie, Lundbeck, Biohaven, Pfizer, Atria Health, CapiThera Ltd., Cerecin, Cooltech, Ceruvia Lifesciences LLC, Ctrl M, Allergan, Biohaven, GSK, Lundbeck, Eli Lilly, Novartis, Impel, Satsuma, Theranica, WL Gore, Nocira, Perfood, Praxis, AYYA Biosciences, Revance. Payment or honoraria for lectures, presentations, educational events: Amgen, Novartis, Eli Lilly, Teva, Allergan, Abbvie, Lundbeck, Biohaven, Pfizer. Participation on a Data Safety Monitoring Board or Advisory Board: Amgen, Novartis, Eli Lilly, Allergan, Abbvie, Lundbeck, Biohaven Honoraria: Vector psychometric Group, Clinical Care Solutions, CME Outfitters, Curry Rockefeller Group, DeepBench, Global Access Meetings, KLJ Associates, Academy for Continued Healthcare Learning, Majallin LLC, Medlogix Communications, MJH Lifesciences, Miller Medical Communications, WebMD Health/Medscape, Wolters Kluwer, Oxford University Press, Cambridge University Press. Research Support: Department of Defense, National Institutes of Health, Henry Jackson Foundation, Sperling Foundation, American Migraine Foundation, Patient Centered Outcomes Research Institute (PCORI). Leadership or fiduciary role in other board, society, committee or advocacy group, paid or unpaid: American Migraine Foundation. American Brain Foundation. International Headache Society Global Patient Advocacy Coalition Stock Options/Shareholder/Patents/Board of Directors: Aural analytics (options), ExSano (options), Man and Science (options), Healint (Options), Theranica (Options), Second Opinion/Mobile Health (Options), Epien (Options/Board), Nocira (options), Matterhorn (Shares/Board), Ontologics (Shares/Board), King-Devick Technologies (Options/Board), Precon Health (Options/Board), AYYA Biosciences (Options), Atria Health (options). Patent 17189376.1–1,466:vTitle: Botulinum Toxin Dosage Regimen for Chronic Migraine Prophylaxis (Non-royalty bearing). Patent application submitted: Synaquell (Precon Health). T. Schwedt, within the last 12 months, has served as a consultant for Abbvie, Allergan, Amgen, Axsome, Biodelivery Science, Biohaven, Collegium, Eli Lilly, Linpharma, Lundbeck, Satsuma, and Theranica. He has stock options in Aural Analytics and Nocira. He has received royalties from UpToDate. He has received research funding from: American Migraine Foundation, Amgen, Henry Jackson Foundation, Mayo Clinic, National Institutes of Health, Patient Centered Outcomes Research Institute, SPARK Neuro, and U.S. Department of Defense. He serves on the Board of Directors for the American Headache Society and the American Migraine Foundation. K. Digre is supported in part by an Unrestricted Grant from Research to Prevent Blindness, New York, NY, to the Department of Ophthalmology & Visual Sciences, University of Utah. C. D. Chong reports research funding from Amgen, the Department of Defense and The National Institutes of Health., (Copyright © 2023 by North American Neuro-Ophthalmology Society.)