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Richmond Eye Associates
Eye Health and Disorders
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Introduction: Headache
Headaches often appear centered
around the eyes or behind the eyes. There are many ocular disorders which can
cause headache, from eyestrain focusing problems, to glaucoma and inflammatory
conditions of the eye. There are other problems which cause headache where
findings of that problem can be seen with a complete eye examination. Finally,
there are many conditions where the eyes are not involved with the cause of the
headache, but the area around the eyes seem to ache because of "referred pain"
to that area.
Patients will often be referred to an ophthalmologist in order to determine if
an ocular condition could be causing headache. Unfortunately, most of the time,
the eyes are not the cause. However, many conditions of the eyes which cause
headache are easily treatable, making the eye evaluation worthwhile.
This page is divided into a group of disorders causing headache which also can
affect the eyes. The next section discusses "other causes" of headache which
cause pain around the eyes, but there is no ocular abnormality. The last section
contains links to ocular problems known to cause headache.
Read this important information
before proceeding further:
These sections are not intended to replace the professional examination and
diagnosis by a physician, and they are presented here purely for informational purposes.
All possible diagnoses and treatment options are not covered, and the information
discussed should not be taken as a recommendation to self-diagnose and self-treat a
condition. A misdiagnosed or improperly treated eye condition can result in a permanent
loss of vision, or a permanent loss of function of the eye or visual system. In the case
of any eye problem, seek medical attention promptly. This can include emergency room
treatment, as well as treatment by a medical physician or eyecare provider.
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Conditions Discussed on this Page:
For eye anatomy explanations, go to
ANATOMY
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"Eyestrain" refers to overworking of the focusing muscle within the eye. To
read at a close distance (within arm's length), the lens within the eye must change shape
in order to bring images into focus. The closer an object is held, the more focusing that
has to be done. Furthermore, the focusing ability of the eye diminishes with age, and
noticeable problems with focusing can appear usually between age 38 and 48. If the eye is
forced to focus more intensely and for a longer duration than it is comfortable with,
eyestrain symptoms can result. These symptoms include:
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Headache, usually a brow ache or an ache behind the eyes.
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Fluctuating vision, with trouble in changing focusing between near and distance.
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Inability to focus at close range, or blurred distance vision occurring after a period
of close work.
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A burning, uncomfortable eye sensation.
Eyestrain symptoms can be relieved by taking a few steps:
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Limit the amount of time spent focusing at one fixed distance, and take periodic breaks
for a few minutes every 15 to 20 minutes. During this break time, focus at a distant
object, not at a near one.
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Vary the distance that you hold reading material, and avoid getting closer and closer to
what you are reading.
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Consider using reading glasses, after an eye examination has been performed to determine
the proper power of the glasses.
For more information on eyestrain, and for information on computer related eyestrain,
go to
Eyestrain.
Return to Condition List
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Migraine is a vascular type of headache, and is caused by a change in vascular tone in
the brain. It is a common cause of headache surrounding one or both eyes. Migraine
headache may be difficult to localize in some cases. It is often preceded by a visual
"aura", which typically is a jagged zigzag pattern of shimmering lights in the
side vision lasting up to 30 minutes. Some people experience this aura and then have no
headache. This is commonly referred to as
Ophthalmic
Migraine. Some people experience neurological changes during this period, such as
tingling or numbness on one side. After the aura, the headache begins, and may be
associated with nausea, vomiting, and sensitivity to light and sounds.
There are many
medications that can be used to treat migraine. There are also numerous factors which may
set off a migraine. Some of these can be identified as a factor in some people:
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Foods containing tyramine (cheese, bananas, yogurt), phenylethylamine (chocolate, wine,
cheese), nitrates (food coloring, preservatives, processed meats), MSG, alcohol, caffeine,
and artificial sweeteners.
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Medications such as estrogen and oral contraceptives. Some women may be sensitive to
hormonal changes.
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Factors such as fatigue, stress, depression, and exertion can play a role in some
people.
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Bright lights, glare, loud noises, and flickering lights may trigger some migraines.
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Cluster headache is a severe
one-sided headache especially involving the area around the eye. It lasts for
up to 2 hours at a time, several times a day, for up to 6 to 8 weeks (thus, a
cluster of headaches). Associated symptoms include tearing and nasal drainage
(on the affected side), eye redness, and a temporary smaller pupil on the
affected side.
Treatment is similar to the treatment of migraine headache, and steroids and
other medications may be needed as well.
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Temporal arteritis, or "giant cell arteritis", is a serious condition usually
affecting the elderly. This is an immune disorder where medium sized arteries becomes
tender and inflamed. The condition is named after the "temporal artery", which
runs from in front of the ear and up the scalp along the hairline. This artery is commonly
involved, and the headache associated with this is a constant, throbbing pain in the
temples. Associated symptoms are weight loss, fatigue, arthritis (especially of the
shoulders), fever, and pain or fatigue with chewing. Visual symptoms occur due to a loss
of blood supply to the optic nerve, or due to a loss of retinal blood supply. Both of
these conditions can cause either a temporary (Amaurosis fugax) or permanent loss of vision, usually in one eye
first (see
Optic nerve stroke or
Retinal artery occlusion.)
Most
people with this condition have an elevated lab test, called a "sed rate".
Diagnosis, however, is made by taking a biopsy of the temporal artery. Steroids can treat
the condition, and the vision is the unaffected eye can often be saved. Untreated,
temporal arteritis can often cause visual loss in both eyes.
For more information about ischemic optic neuropathy and temporal arteritis, visit the University of Iowa Ophthalmology
website.
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The eye socket, or orbit, is
surrounded by sinuses, except on the outside wall. Infection of the sinuses
can lead to pain over the affected area, often radiating to the eye and face.
The headache is usually dull, aching, and throbbing. Bending or stooping may
worsen the headache. Fluid retention within the sinuses around the eyes can
cause similar symptoms, but less severe.
Sometimes sinus congestion or infection can be associated with
obstruction of the tear drainage system.
This leads to frequent tearing of the affected side, and possible infection of the tear
duct.
It is possible for sinus infection to spread into the skin around the eyes (Eyelid Cellulitis), or even spread into
the orbit behind the eyes (Orbital
Cellulitis), especially in children. These conditions require aggressive antibiotic
therapy, often given IV.
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Shingles refers to a reactivation
of the chicken pox virus along the distribution of a nerve. Once a person has
had chicken pox, the virus lies dormant in nerve cells. Sometimes the virus
becomes reactivated (often during a period of stress of illness), and a rash
of blisters will appear on the skin along the distribution of that nerve. The
nerve that supplies sensation to the scalp, upper eyelid, eye, and nose is
commonly involved, and the rash may appear in this area. Note that the rash
never crosses the midline of the forehead, and this gives a very obvious
appearance. The area involved is usually painful, with a burning aching. This
pain may precede the rash. Antiviral medications given promptly by mouth may
shorten the duration and intensity of the flare up.
The eye can be involved with shingles if this particular nerve is involved.
Almost any part of the eye can be affected, and consultation with an
ophthalmologist is important to prevent problems.
Return to Condition List
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There are many other conditions which can cause headache around the eyes that do not
directly involve the eyes themselves. The eye and orbits are frequent areas of
"referred pain", that is, pain coming from another source. Some of these
conditions include:
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Ear and tooth pain can radiate to the eyes and orbits.
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TMJ disease (temporo-mandibular joint) can cause eye, tooth, ear, neck, or sinus pain.
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Degeneration of the cervical (neck) spine can cause pain which can radiate to the eye
and orbits.
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Trigeminal neuralgia (tic douloureaux) is a brief attack of severe pain affecting one
side of the face, often near the eye. The pain is can be very severe, sharp, and cutting.
There are different treatment options available for this problem.
Return to Condition List
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Contact lens related problems - headache may
come from a poorly fitting, tight lens, corneal infection or swelling, or from a lack of
oxygen in the cornea.
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Corneal abrasion - pain, tearing,
redness, and a sensation that something is in eye.
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Corneal ulcer - an infected cornea can
cause pain, headache, blurred vision, and redness.
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Conjunctivitis - swelling of
the conjunctiva and eyelids can cause headache, along with the itching, redness, and
discharge.
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Dacryocystitis - an infected tear
drainage sac (inside corner of the eye) can lead to pain and headache, as well as tearing.
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Dry eye - irritation, scratchy sensation,
sometimes tearing and blurred vision.
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Glaucoma (acute) - pain, blurred
vision, rainbows around lights, and headache.
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Iritis - pain, sensitivity to light,
blurred vision.
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Paralysis of the eye muscles -
when caused by a nerve paralysis, there may be significant headache as well.
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Optic neuritis - inflammation of
the optic nerve can cause headache and pain on eye movement along with blurred vision.
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Orbital cellulitis (infection) -
infection of the orbit behind the eye can lead to blurred or double vision, pain, and eye
protrusion.
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Scleritis - pain, blurred vision,
redness.
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Thyroid related eye disease -
scratchy sensation, double or blurred vision, protruding eyes.
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