Headache in Ophthalmology common complaint
✅ Headache in Ophthalmology With Swollen disc
✅ Headache in Ophthalmology Without Swollen disc
Go systematically as follows
✅ Headache in Ophthalmology with Swollen disc :
✍️ Bilateral
Serious or life-threatening headaches
☝️ Raised ICP
• worsening headache on lying flat or coughing or sneezing or Valsalva
• visual obscuration
• diplopia
• disc swelling with loss of SVP
• blind spot enlargement
• VIn palsy( false localizing sign)
☝️ causes of Raised ICP
• Cerebral tumour
• IIH
• venous sinus thrombosis
• meningitis
• encephalitis
• brain abscess
• congenital ventricular abnormalities
• cerebral oedema.
• Subarachnoid haemorrhage
thunderclap headache with meningism and altered consciousness.
• Accelerated hypertension
High BP With hypertensive retinopathy (CWS, haemorrhages, exudates)
✍️ Unilateral
Serious or life-threatening headaches
☝️ GCA
• usually age >55
• visual loss
• scalp tenderness with or without necrosis
• jaw or tongue claudication
• limb girdle pain or weakness
• fever
• weight loss
• non-pulsatile, tender, thickened temporal arteries
• AION results in unilateral or less commonly, bilateral disc swelling.
✅ Headache in Ophthalmology without optic disc swelling
✍️ Serious or life-threatening headaches
☝️ Raised ICP
may occur in the presence of non-swollen discs ( myopic discs, atrophic discs, anomalies of the optic nerve sheath).
☝️ GCA with
• endocrine dysfunction (amenorrhoea, galactorrhoea, infertility, acromegaly, Cushing’s disease)
• optic atrophy with bitemporal field loss
☝️ Pituitary apoplexy
• recent major hypotensive episode
• major surgery
• post-partum haemorrhage with acute drop of vision and meningism with or without loss of consciousness
✍️ Headache syndromes
☝️ Tension headache
• very common
• tightness
• bifrontal or bioccipital or band-like
• may radiate to neck
• headache-free intervals
• no neurological or systemic features
• may be associated with cervical spondylosis.
☝️ Migraine
• common
• headache (usually hemicranial)
•nausea, photophobia, phonophobia( prodrome)
• visual phenomena include scintillating visual aura (starts paracentral and expands as it moves peripherally)
• transient visual loss (unilateral or homonymous hemifield)
• ophthalmoplegia.
☝️ Cluster headache
• sudden oculotemporal pain
• no prodrome
• may have transient lacrimation and rhinorrhoea
• Horner’s syndrome ( Raeder syndrome)
☝️ Facial pain
• Trigeminal neuralgia with sudden stabbing pains in trigeminal branch distribution usually precipitated by touch, cold, eating.
• Ophthalmic shingles with hyperaesthesia in acute phase followed by neuralgic-type pain.
☝️ Sinus pain
• Acute or chronic sinusitis
• coryzal with RT infections symptoms
• tender over paranasal sinuses
• proptosis diplopia, or optic neuropathy warrant urgent exclusion of orbital involvement.
☝️ Ocular pain
Generalized
• AAC
• anterior uveitis
• keratitis, scleritis
• ocular ischaemia.
Retrobulbar
• optic neuritis
• orbital pathology (infection, infiltration, neoplasm or TED).
On eye movement
• optic neuritis.
Asthenopia (eye strain)
• worsens with reading or fatigue
• ametropia (especially hypermetropia) or astigmatism
• anisometropia
• decompensating phoria
• convergence insufficiency
