Open Access Journal of Ophthalmology ISSN: 2578-465X MEDWIN PUBLISHERS Committed to Create Value for Researchers Ocular Consultation in Headache-A Prerequisite or an Absolute Necessity? Kaiti R1* and Shyangbo R2 Mini Review 1Consultant Optometrist, Nepal Eye Hospital, Nepal Volume 5 Issue 2 2National Academy of Medical Sciences, Nepal Received Date: September 07, 2020 Published Date: September 28, 2020 *Corresponding author: Raju Kaiti, Consultant Optometrist, Nepal Eye Hospital, Kathmandu, DOI: 10.23880/oajo-16000200 Nepal, Email: [email protected] Abstract A vast majority of cause of headaches are ocular, prime cause being neurological. Therefore, eye care practitioners are headaches, eye pain, and headache-associated visual disturbances. Refractive error, oculomotor anomalies and ocular diseases often the first physicians to evaluate, manage or if needed refer to designated department and specialty, the patients with contribute to headache and hence these causes need to be ruled out before going for expensive, invasive and time-consuming ophthalmologist or any other specialists as per necessity. investigation. Health care professionals should always be generous in referring the patients to fellow physician, optometrist, Keywords: Oculomotor Anomalies; Ocular Diseases; Unilateral Neuralgia; Trigeminal Autonomic Cephalgias; Nervous System Disorders Abbreviations: GP: General Practitioner; BASH: British conditions, but because the symptom can represent an early Association for the Study of Headache; TAC: Trigeminal manifestation of a potentially serious disorder, it necessitates Autonomic Cephalgias; SUNCT: Short-Lasting Unilateral thorough evaluation. A vast majority of cause of headaches are ocular, prime cause being neurological. Therefore, eye Tearing; SUNA: Short-Lasting Unilateral Neuralgia Headache Neuralgia Headache Attack with Conjunctival Injection and manage or if needed refer to designated department care practitioners are often the first physicians to evaluate, AttackIntroduction with Cranial Autonomic Symptoms headache-associated visual disturbances. Most of the headachesand specialty, are theoften patients accompanied with headaches, by ocular oreye peri-orbital pain, and all symptoms and probably a universal experience at some attributed to ocular disease. Although ophthalmic causes are pointHeadache, of life. It is also not known a disease as cephalgia,in itself but is merely the commonest a symptom of sometimespain, along diagnosed, with some most visual ocular symptoms, pain and thereforemany types it ofis of a disease or health condition. Collectively, headache visual disturbances are neurologic in origin [3]. Thus, there disorders are among the most common of the nervous system disorders [1]. A headache can affect any part of the head, and As frequent as it may sound, but the appropriate diagnosis pain may be present in one or several locations. Headache exist an inextricable relation between eye and headache. line [2]. A large proportion of headaches result from benign hasof headache been underestimated, is still murky under-recognizedwith only minority and of under-people has been defined as the pain located above orbitomeatal worldwide diagnosed with headache disorders. Headache Ocular Consultation in Headache-A Prerequisite or an Absolute Necessity? J Ophthalmol 2 Open Access Journal of Ophthalmology • or immunocompromised status treatedThe throughout prevalence the of worldheadache [1]. in general population is • SignsNew headache of a systemic in the illness setting (e.g., of fever, HIV risk stiff factors,neck, rash) cancer, thought to around 48.9% [4]. It has been estimated that • almost half of the adult population have had a headache at • Headache in pregnancy/postpartum period • Triggered by cough, exertion, Valsalva maneuver • Aura symptoms that careleast practitioners once within the[5]. Aroundlast year 95% making of the headache general populationone of the i. LastFirst longeror worst than headache an hour most frequent reasons to seek a consultation with health ii. iii. Are different from previous aura have experienced headache at some stage in their life with iv. Include motor weakness generala 1-year practitioner prevalence (GP) of nearly consultations one in [6],two 1adults in 3 neurology [4]. The referralsprevalence [7] of headacheand 1 in is5 widespread,of all acute accounting medical admissions for 1 in 10 ThereOccur forare themany first ocular time conditionson using oral that contraceptive causes headache, pill [8]. Although the evidence in the literature for a strong Moreover, certain secondary causes of headache also have neuro-ophthalmic manifestations. Broadly, the causes of examinationassociation between and treatment oculo-visual help to problems lessen their and headache headache visit is optometristsweak [5], still and patients ophthalmologists who believe thatvery appropriate frequently [9,10].ocular ocularOcular headaches Headache can be studied Caused in the Due following to Uncorrected subheadings: Headache affects people of all ages, races and socioeconomic Refractive Errors Headaches caused due to uncorrected refractive error statusThe and International is more common Headache in women. Society [11,12] broadly afternoon or at the end of the day. The constant effort exerted Secondary headache. Primary headaches have no underlying or wrongly corrected refractive error usually occur during causeclassifies and headache constitute into the twovast groups:majority Primary of headache headache disorders and headache. It starts as heaviness in eye and continuous use of including migraine, cluster and tension headaches, and most eyein order leads tosee headache. clearly causes The symptoms eye strain are and more finally prominent lead toin common entities being the migraine and tension headache. Migraines, in general, have a prevalence of 18.2% in females prominent in astigmatism in comparison to myopia and and 6.5% in male patients [13]. The tension headache is hyperopia.low grades Oneof refractive hypothesis error states than that in evenhigh theerrors minor and degree more of astigmatic errors of refraction causes changes to visual perception that alter the hyper-excitability in the visual prevalencethe most common of 0.1% affecting only [14]. 60-80% Secondary of the populationheadaches with are cortex of the brain of headache sufferers [16]. Astigmatic uncommoncluster headache but their being recognition the most uncommon is extremely with important estimated as blur may exacerbate the perception of striped patterns timely intervention may be lifesaving. The most common cause of secondary headaches includes: space occupying different types of headaches [17]. The uncorrected refractive lesions-mainly intracranial tumors, infections of the which are thought to be important in the visual triggers of central nervous system, mainly meningitis or encephalitis, subarachnoid hemorrhage, giant-cell arteritis, cerebral errors are often believed to be associated with frontal venous thrombosis, idiopathic intracranial hypertension, headachesand/or occipital [19,20]. headache We have [18]. many However, clinical some examples research of etc. Headache caused due to psychiatric problems are refractivehas established error beinglow prevalence cause of headache of refractive and taking error themrelated to also considered as secondary headache. Fortunately, the emergency and physician consultation. Most of these cases vast majority of patients who present to the primary care inwere investigations, normal in blood taking investigation, medicines, they blood are pressure, not relieved even and CT provider for an evaluation will have a primary headache thenscan andthey MRI. get toAfter visit a weekeye care of rush, practitioners. spending bulkWe have of money seen disorder. However, secondary headaches may be caused due small refractive corrections (mostly astigmatism) alleviate to underlying life threatening conditions and present with Associationcertain red flagsfor the which Study points of Headache towards (BASH) the immediate [15] as listedneed of thorough evaluation. The red flags adapted from British theirOcular symptoms Headache in 3-4 days Caused of spectacle due wear. to Oculomotor • Anomalies • below:Abnormal neurologic examination including papilledema Though international headache society does not andNew change headache in mental in older status patients recognize it, very often some literatures tend to point out • headache New change in headache pattern or progressive it [5]. The disruption of coordination between the muscles Kaiti R and Shyangbo R. Ocular Consultation in Headache-A Prerequisite or an Absolute Copyright© Kaiti R and Shyangbo R. Necessity?. J Ophthalmol 2020, 5(2): 000200. 3 Open Access Journal of Ophthalmology Trigeminal Autonomic Cephalgias (TAC): TACs are transferred to the head, resulting in headache. characterized by unilateral pain in the ophthalmic division of of the two eyes may bring about the strain that may be phorias and especially vertical phoria or tropia, tend to mostthe trigeminal common nerve.form of It TAC may is present cluster withheadache. lacrimation, eye lid be theMost culprit. commonly, Ocular significant muscle imbalance decompensated as latent and squint, large Clusteroedema, HeadacheHorner’s syndrome: It is the and most conjunctiva common injection.form of TAC,The accommodative and vergence dysfunctions [21] and region of ipsilateral side lasting for about 15 to 180 minutes. reported that in migraine headache often binocular