Dr. Marmura of Thomas Jefferson University Hospital received research support from Teva and honorariums for consulting services from Alder, Amgen, GammaCore, Promius, and Supernus.)
Dr. Silberstein, Director of the Jefferson Headache Center at Thomas Jefferson University, receives honorariums from Allergan, Avanir Pharmaceuticals, Curelator, Depomed, Dr. Reddy's Laboratories, eNeura, INSYS Therapeutics, Lilly USA, Supernus Pharmacerticals, Thernica and Trigemina for consulting. He is also the principal investigator for a clinical trials conducted by Alder Biopharmaceuticals, Amgen, electroCore Medical, Lily USA and Teva.)
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. Conjunctival injection, corneal edema, abnormal pupils, and decreased vision are some of the most common signs. 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. This article covers important ocular causes of headache, including updates on the link between glaucoma and headache, and reviews associated inflammatory disorders such as Vogt-Koyanagi-Harada syndrome. The ocular presentations of primary headache, such as photophobia, blurred vision, tearing, ptosis, or ocular pain, are also examined.
• 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.
• 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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