Thank you for asking such an interesting question. Patients presenting with headaches and eye symptoms are a common presentation at a busy clinic. Several diagnoses come to mind, including tension headaches, cluster headache, migraine, aneurysm of a blood vessel in the brain, eyestrain, and sinusitis. Pain in and around the eye usually reflects referred pain from headaches. “Referred” pain is pain that radiates from its originating location to another site.
Different causes: Tension, cluster headaches, and Occipital neuralgia
Tension headaches, the most common form of headache, are episodic and can occur one to two times per month. They are described as causing a tightening feeling or pressure around the forehead. Pain behind the eyes can also occur. Other symptoms associated with this form of headache include dull head pain, scalp tenderness, neck and forehead pain.
Some patients describe migraines as pressure or pain behind the eyes. Worse than regular headaches, they can cause pain lasting hours to days at a time. Aside from debilitating pain, one may also experience the following: sensitivity to light, eye pain, dizziness, nausea, weakness, vomiting, impaired vision, and mood changes. Symptoms of the disease can include increased sensitivity to light and sound, nausea and vomiting, dizziness, pains in the eye or behind the eye, blurred vision, changes in the visual field (floating opacities, flashing lights), etc. Migraine is classified as two types, migraine with or without an aura. In case of migraine with an aura, there are symptoms before the migraine attack signaling an approaching attack. A migraine attack may last from several hours up to several days and it usually has several phases. However, each patient can react differently. There is also a retinal migraine or eye migraine when the main complaints during the attack are associated with visual disturbances, blurred vision.
Cluster headaches are a series of three or four short but painful headaches. It is one-sided head pain that may involve tearing of the eyes, a droopy eyelid, and a stuffy nose. Attacks last from 15 minutes to 3 hours, occur daily or almost daily for weeks or months. The attacks are separated by pain-free periods that last at least 1 month or longer. They are described as a searing or piercing painful sensation usually located behind one eye. Other symptoms include red eyes, swollen eyes, excessive tearing, drooping eyelid, red and tearing eye, or stuffed or running nostrils all on the same side as the pain. The duration of one episode of pain may be from 15 to 180 minutes, besides each time it starts at a specific time of the day, most frequently at night, 2 to 3 hours after falling asleep. Pain is usually tormenting, in most cases, it is localised around the eye but it can radiate to the face, head, even to the neck and shoulders. While these “clusters” of attacks are severe, they last for only a short time (about 45-60 minutes) and reoccur a number of times per day, often at the same time every day, sometimes wakening the patient in the night. If a patient’s headache is constant throughout the day, other causes of headaches and eye pains may be considered.
Occipital neuralgia is a common type of headache. These headaches are caused by a pair of occipital nerves which arise in the neck region next to the 2nd and 3rd cervical vertebrae. Causes of pain include tumours, trauma, infections, haemorrhages or a systemic disease such as osteoarthritis, degenerative changes in the cervical vertebrae, diabetes, and gout. Occipital neuralgia may be caused also by prolonged flexion of the head. Usually, pain starts in the neck and then spreads up and radiates behind the eyeball, to the back of the head, forehead, and temple. Pains are sharp, pulsating, like an electric shock.
Different causes: Aneurysm and eye conditions
An aneurysm is a small out-pouching of a blood vessel with a thin wall. If an aneurysm ruptures, it causes a hemorrhage in the brain and the outlook is often dismal. If an aneurysm is discovered before it ruptures, and it is larger than 4-5 mm in diameter, it is often treated with either surgery or a coiling technique, whereby a small set of threads is introduced via a catheter to cause firm coagulation that prevents future bleeding. If the aneurysm is smaller than 4 mm, it is usually observed. While most headaches are not causes for alarm, if a person has a new-onset, one-sided, intense headache with neurological symptoms like numbness, weakness or eye symptoms, it may be a medical emergency and should be attended to immediately.
Some cases of headaches and pain behind the eyes are symptoms of uncorrected vision issues. Eyestrain from staring at a television or computer screen can overstimulate the brain. Eye strain is caused by improper focusing (nearsighted, farsighted or astigmatism), or when the two eyes are not properly aligned. Children under school age rarely complain of headaches from eyestrain. The typical headache of eyestrain starts after using the eyes, especially for extended periods of time, such as long periods of time using the computer, reading, or even sewing. Any number of tasks that require one to use our eyes for a long time may lead to a headache. For these individuals, it is important to make sure that, if needed, they have the appropriate prescription of eyeglasses. It is important to note that headaches that are present on awakening or those that wake one from sleep are not caused by eyestrain. Headaches due to eyestrain are not generally associated with nausea or vomiting.
Other eye conditions that could cause headache pain behind the eye include scleritis, or severe inflammation affecting the white outer coating of the eye, optic neuritis, or inflammation of the optic nerve, Graves’ disease, an autoimmune disorder and glaucoma, an eye disease affecting the optic nerve. A sinus infection, or sinusitis, is the inflammation or congestion of tissues lining the sinuses. This congestion is usually coupled with pressure often felt across the forehead, cheeks, and behind the eye.
The famous philosopher Socrates once said: "Just as you ought not to attempt to cure eyes without head or head without body, so you should not treat body without soul…" There are many possible causes for headaches and eye symptoms, so it is important to evaluate the whole person and body.
