Eye-related headache

Michael J Marmura MD (Dr. Marmura of Thomas Jefferson University Hospital has received research support from eNeura and Teva and  honorariums for consulting services from Supernus and Teva.)
Stephen D Silberstein MD, editor. (Dr. Silberstein, Director of the Jefferson Headache Center at Thomas Jefferson University, receives honorariums from Alder Biopharmaceuticals, Allergan, Amgen, Avanir Pharmaceuticals, Curelator, Depomed, Dr. Reddy's Laboratories, eNeura, electroCore Medical, Lilly USA, Supernus Pharmacerticals, Teva, and Trigemina for consulting and/or advisory panel membership.)
Originally released February 14, 2002; last updated September 13, 2015; expires September 13, 2018

Overview

Because headache may be accompanied by pain in the eye or visual symptoms, it is often attributed to ocular disease. However, if the sclerae are white and noninjected, ocular disease is rarely the cause of significant headache. When eye disease is the cause of pain, the location and character of the pain, associated symptoms, and ocular signs are usually evident to the careful observer. Conjunctival injection, corneal edema, abnormal pupils, and decreased vision are the hallmarks of such disorders (Behrens 1978). Clinicians other than ophthalmologists should be familiar with the symptoms and signs of ocular diseases, such as infection, inflammatory disorders, and glaucoma, that cause headache.

Ocular symptoms are commonly associated with both primary and secondary headache disorders (ie, idiopathic intracranial hypertension). Patients with primary headaches, such as migraine or cluster headache, may present with complaints of photophobia, blurred vision, tearing, ptosis, or ocular pain.

Key points

 

• Eye pain is more likely related to ocular disease, such as glaucoma, when the eye is injected, edematous, or pupils are abnormal.

 

• Patients with vision loss, ophthalmoparesis, or progressive symptoms usually require urgent neuroimaging or referral.

 

Pituitary apoplexy is a neurologic emergency presenting with severe headache, vision loss, ophthalmoparesis, or delirium.

 

• Ocular symptoms such as visual aura, blurry vision, or photophobia are common in patients with primary headache disorders such as migraine.

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