Ophthalmic causes

of Headache

Dr Ashish Mahobia. MS;FRF;FNB

Sai Baba Eye hospital,Raipur

Lets probe deeper

Ophthalmic Non ophthalmic

Ophthalmologists are usually the first doctors to see a patient of headache

Some headaches are symptoms of medical emergencies.

Good History taking

“Listen to the patient,He is telling you the diagnosis” - Dr William Osler

We interrupt in 30 secs* Headache (primary c/t?) Mild / mod /severe - Is it debilitating? (subjective)*Svab I. The time used by the patient when he/she talks without interruptions. Aten Primaria 1993;11: 175-7.

Blau JN. Time to let the patient speak. BMJ 1989;298: 39.

Severe Headache

Half sided (HemiKrania=Migraine) ? Photophobia/phonophobia/scintillating

scotoma/nausea? Association - near work

stress ,travel

aur …aur…aur…aur..aur

Severe Headache…

Remember!!

Migraine with aura (Classical migraine)

only 10-35% Migraine and without aura > 50% (Common

migraine) [1]

Severe Headache… Ask to point out with finger(Head/face/eye/neck)

Complete examination is MUST

Systemic/neurological Psychological analysis (Non verbal clues) Vision Motility Pupils Fundus Field defects

All Ocular pathologies

Referred headache ACG Retro bulbar neuritis

Vision..

Uncorrected refractive error Untreated hyperopia/Presbyopia Overcorrected Myopia Use Jacksons cross cylinders/Auto ref Accommodative spasm (eye pain, myopia,

and miosis) 20/20 vision doesn’t mean “No glasses”

Refraction tips

Correct cylcloplegic Relax accomodation in A refractometer Myopics:Do the ‘Duochrome” test (each eye) High power glasses in last cell of trial frame See for pantascopic tilt

Tips for refraction…

Undercorrect Myopes (Sply high minus) Do not overcorrect H metropes Reduce quarter of Cylindrical power Graded wear/increase of Cylindrical power

(except pseudophakes)

Near correction

“Jitni door se hamesha kaam karte hain” Move it away…(see the needs and

occupation) Do not change the type of bifocal segment Do not change the axis which has been used

for years Do not change a comfortable refraction just

because your autoref says so Don’t over believe in autorefs/optometrists

See the IPD

Prismatic effect Ensure good centration Sply Large power Children Large heads Spectacle /Frame

change Anisometropia (walk

around test)

Strabismus

Latent Manifest All gaze positions Near and distance

Convergence deficiency

Orthophoria for distance and exophoria for near show

Primary/H metropia/Myopia/presbyopia NPC: Normal 8 cms “Pencil push up” Over minus and less plus Base in prism/bifocals.

Responsibility…

Thank you!

Wish you and the whole family a V Prosperous & Joyous Diwali!

Activation of the trigeminal autonomic reflex arc also accounts for Holmes adie pupil on the symptomatic side.

Eyelid edema, redness, lacrimation, or nasal congestion, during the migraine attacks are more likely to respond to sumatriptan, a serotonin receptor agonist.

Cluster headache, also known as histamine headache severe and unilateral typically are located at the

temple and periorbital region. Associated with ipsilateral lacrimation, nasal

congestion, conjunctival injection, miosis, ptosis, and lid edema.

Each headache is brief in duration, typically lasting a few moments to 2 hours. Cluster refers to a grouping of headaches, usually over a period of several weeks.

To fulfill criteria for diagnosis, patients must have had at least 5 attacks occurring from 1 every other day to 8 per day and no other cause for the headache.