Walsh & Hoyt: Headache Attributable to Disorders of the Eyes

Ocular disease may cause headaches and may be overlooked by the primary care physician and general neurologist. It is important to be aware of these ocular conditions, both to provide accurate and effective management, and to spare the patient unnecessary testing and treatments. Since eye pain is ultimately mediated by the trigeminal nerve, many primary and secondary headache disorders may present with localized eye pain. The history may provide important clues to an ocular etiology. Conjunctival injection, pupillary abnormalities, and corneal edema are common symptoms in eye-related headaches, but are not always present. Visual loss and diplopia associated with head and/or eye pain should suggest an ocular etiology. A complete ophthalmic examination should be performed, with careful inspection of the eyelids, conjunctiva and orbits, biomicroscopic examination of the anterior segment, and measurement of intraocular pressure. Many primary headache syndromes, particularly the trigeminal autonomic cephalgias, may present with pain localized around the eye; in such cases, excluding an ocular etiology allows proper diagnosis and management.