Eye-related headache

Introduction
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By Michael Marmura MD

Headache and ocular pain often coexist. Examination of patients with eye disease will usually show visual disturbances, injection, or pupil irregularities. Other patients with an apparently normal examination may have ocular pain or symptoms caused by entities ranging from carotid dissection to primary headache disorders, such as migraine. In this clinical article, Dr. Michael Marmura of the Jefferson Headache Center at Thomas Jefferson University focuses on the many causes and treatment of eye-related headache. He discusses the management of ocular emergencies, including acute glaucoma and pituitary apoplexy, and unusual diseases such as Tolosa-Hunt, Behcet disease, and optic neuritis related to West Nile virus infection.

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.