Evaluating headaches

ABSTRACT

Headache is a common affliction and one of the most frequent causes of referral to opthmalmologists. Multiple intra- and extra-cranial disturbances may be responsible for severe head pain and the many structures contained within the head make diagnostic confusion common. Ocular causes of head pain include trauma, inflammation, ocular hypertension, painful neuropathies and asthenopic symptoms. Other than trauma, inflammation is the most common cause of orbital pain but ischaemia and painful neuropathies are not uncommon. In addition, disease involving the para-nasal sinuses is often referred to the eye or orbit. Ocular tumours are infrequent causes of head pain and when pain is present it is usually associated with secondary glaucoma or inflammation. Similarly, pain is uncommon in otherwise silent orbital tumours, but lachrymal gland lesions may be painful in the absence of other outward signs of abnormality. When faced with the patient with unexplained head pain, the opthalmologist must first establish if an ocular cause is present. If none is found, a systematic work-up should be initiated and the patient referred to the appropriate specialist. (AU)