Headaches, eye-aches and vision changes

A range of different forms of headaches occur with either pain around the eyes or with changes to vision and these headaches can be tricky to diagnose because both eye and vision symptoms may be caused by either an eye disease, a head disease or a systemic disease. Also, the prognosis is spread across harmless, vision threatening or life threatening.

Generally, headaches associated with the eyes can be from a purely eye problem, orbital disease, cranial disease or systemic disease.

Purely eye related causes of headache include ocular surface disease, inflammation within the eye, raised pressure within the eye, eye strain from uncorrected refractive error, eye alignment problems and excessive focussing.

Orbital and cranial causes include Orbital inflammation, tumors and blood vessel abnormalities, Abscesses and Cellulitis, Thyroid Eye Disease, Optic Nerve inflammation, Trochleitis, Sinus headache, Dental disease and Temporomandibular joint syndrome, Shingles, Cavernous Sinus disease, Carotid Artery disease, Brain diseases, Increased intracranial pressure, Migraine, Cluster headache or Tension headache.

Systemic causes include Giant Cell or Temporal Arteritis, Diabetes and High blood pressure.

The two most common forms of headache can be debilitating but are harmless. Tension headaches account for the vast majority of headaches affecting 80% of the population and can involve the muscles around the eyes. Migraines are also common, affecting 15% of the population and the preceding aura is usually visual: flickering lights, spots or lines, zig zags, water running down glass/heat haze effect, or blind spots.

Dangerous headaches tend to be “first and worst,” single and of sudden onset, progressive, and with onset later in life.

Whilst most headaches are harmless some can be vision or life threatening and so any headache that seems unusual should be checked by a health professional and if the headache seems related to the eyes than your optometrist is a good place to start.

References

1. Fuller G, Kaye C. Headaches BMJ 2007;334 :254
2. eTherapeutic Guidelines, eTG, accessed at https://tgldcdp.tg.org.au/
3. Friedman, D.I., Gordon, L.K. & Quiros, P.A. Curr Pain Headache Rep 2010 14: 62.
4. Rhee DJ, Pyfer MF. The Wills Eye Manual 3rd Ed. Lippincott Williams & Wilkins Philadelphia 1999