I’m having headaches that affect my eyes

Answers by Dr. Mitchell Gossman, an ophthalmologist at Eye Associates of Central Minnesota, located in St. Cloud

Having a headache that affects your eyes or vision can be caused by several things.  A complete eye exam is recommended. Stock photo

I’m having headaches that seem to be affecting me around my eyes. Should I have an eye exam?

There are many ways that the eye itself can cause pain in or around the eyes:

1. Inflammation or infection inside the eye

2. Inflammation or infection affecting the exterior of the eye, such as the sclera, conjunctiva, and cornea

3. Inflammation or infection of the surrounding tissues of the eye, such as thyroid eye disease, bacterial infections, and much more

4. Very high pressure in the eye, i.e. glaucoma

5. A significant glasses prescription that is not being corrected in glasses or contacts, or an incorrect glasses prescription

6. Misalignment of the eyes

7. Damage to nerves that control eye movements, as can occur often in diabetics

8. Inflammation of the optic nerve (optic neuritis)

Having said all that, in most cases where the eye is the cause of the pain in and around the eye, there will be abnormalities seen by the patient or other health care providers, and other symptoms such as blurry vision or light sensitivity. If the eye isn’t red, for example, it would be unusual to have an infection. Like many things in life, there are exceptions to this notion, however, such as mild inflammation in the eye or intermittently high eye pressures being the problem without any other signs or symptoms. Much like a heart attack can result in pain radiating to the arm, a problem other than an eye problem can be referred to the eye from some other source.

If a good quality complete eye examination is totally normal, then the cause of the eye pain is presumed to be due to something else affecting the eye, or the anatomy around the eye.

Possibilities include:

1. Elevated pressure inside the head

2. Brain tumors, both benign and malignant

3. Arterial dissection (a “rip” in the arteries of the head and neck)

4. Hemorrhage inside the head

5. Aneurysms

6. Infection or inflammation of the brain and associated structures

7. Sinus infection

8. Inflammatory condition of the vessels of the head and neck (“vasculitis,” the most common being Giant Cell Arteritis, also known as “temporal arteritis.”)

This is merely a brief summary of a complex subject, and no two cases are alike. My advice is, if the eyes appear normal, there are no eye symptoms such as decreased vision or redness, start with a primary health care provider such as  family practitioner, internist, OB-GYN, Certified Nurse Practitioner, or Physician Assistant to do an initial evaluation. It is very common for such specialists to include in their evaluation a referral to an ophthalmologist or family optometrist to verify the eyes are OK if the headache seems to radiate to the eyes.

If a headache is severe, sudden, or associated with neurologic symptoms, it would be best to start at an emergency room. If you are 50 years old or more, it wouldn’t hurt to ask the provider if you should be checked for giant cell arteritis, something that is often missed and can cause devastating vision loss or stroke, and to ask if an MRI or CT is recommended.

Find out more

Dr. Mitchell Gossman is a comprehensive ophthalmologist, along with Dr. Melanie Thares, an optometrist, at Eye Associates of Central Minnesota. The office is located at 628 Roosevelt Road, Suite 101, in St. Cloud. To make an appointment or to learn more, call 320-774-3789 or email info@eaofcm.com.

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