A pain in the eye may not be due to eye disease, but could be a sign of a severe headache disorder.
If serious eye disease is present the eye will often look red or inflamed.
The severe headache disorders which can present with eye pain include:
By far the most common. Usually builds up over a few hours and you want to lie down for a while. Nausea or preference for a dark room is usual.
This is the classic eye pain that I would see. A brief sudden sharp pain in one eye. Makes you wince or clutch the eye briefly. Its over in seconds, but a dull ache can persist for a few minutes. (Its old-fashioned name was “ophthalmodynia fugax” which translates to brief pain in eye).More likely to get ice-pick pains if you are known to have migraine or cluster type headaches
A nasty, intense, boring pain that builds to an extreme level within a few minutes. The eye waters, and you feel agitated.You usually want to pace the floor or bang you head off a wall. Usually lasts 30 minutes to a couple of hours.A cluster phase happens where there a headache like this every day for several weeks, which then goes away.
S – Sudden
U – Unilateral (one sided, in this case the eye or area around the eye)
N – Neuralgiform – a brief sharp intense severe pain in the eye lasting from 5 to 180 seconds
C – Conjunctival injection, the eye is painful and red during an attack
T – Tears flow form the affected eye during an attack
SUNCT is difficult to treat, and may have an underlying problem with the pituitary gland, so required specialist advice.SUNCT is really rare – headache specialists will only see one or two of these in any year.Some people do not have reddening of the eye, and get called “SUNA” – Sudden Unilateral Neuralgiform headaches with Autonomic Features.
One of the headaches that improves with a course of Indomethacin.The symptoms have a lot in common with cluster headache, except that an attack is usually more short-lived. 5-30 minutes and can happen many times in a day.
Ice-cream Headache or “Brain Freeze”
Usually this is in the side of the head, but the eyes can also be sore after swallowing something very cold
The pain of carotid dissection usually happens suddenly, and is often causes pain in eye or around the eye.
The major clue to a dissection, apart from the sudden onset, is that the nerve supply to the eyelid on the side of the headache is disrupted and drops down slightly – called Horners Syndrome. This usually presents as a sudden or acute headache and does require prompt medical attention for assessment, investigation and treatment.
This rare headache usually causes a sudden headache and affects the vision (sudden blindness at the onset of a headache). Pain from pituitary disease will cause “pain in eye” or around the eye.Radiologists, who report brain scans, tell me that the pituitary is one of the areas they consciously check when reporting scans in people with headache, as changes in the pituitary region on scans can be subtle.
Usually trigeminal neuralgia is a severe pain in the cheek or jaw, but a small percentage will experience severe pain in eye instead.It can sometimes be very difficult to tell the difference between cluster headache, trigeminal neuralgia and SUNCT.Triggering of pain by touching the face is the classic feature of trigeminal neuralgia. People will usually avoid washing the face, speaking or eating for fear of triggering an attack of severe pain.
Pain is present just above the eye in most cases, but if severe, the “pain in eye” is reported.The supra-orbital nerve runs in a small groove through the bone at the inner third of the top of the orbit.A local anaesthetic injection to freeze the nerve will give rapid, but short-lasting relief if you have this complaint.Compression of the nerve from prolonged wearing of goggles or a helmet are known causes of Supraorbital Neuralgia
This usually causes a more widespread pain over the entire side of the head, but the eye can feel very uncomfortable, like a gritty feeling of something in the eye.It has been added to this list of “pain in eye” causes, as it should settle with Indometacin tablets. If unrecognised it can lead to years and years of daily headaches.
If this looks like most headache disorders, you are almost right. Usually these diagnoses are not difficult. The very short-lasting pain disorders like SUNCT, Cluster Headache or Migraine with autonomic features might cause confusion as reddening of the eye or eye watering can occur, and suggest there is something wrong with the eye (when there is not!).
Eye Disease causes Pain in the Eye!
It goes without saying that there is a long list of diseases of the eye that present with pain (Not all eye diagnoses are as easy as the one in the drawing above).
These are beyond my scope or expertise. However, if there is eye pain, reduced vision, reddening of the eye you should have your eyes examined by a professional optician.
In my experience, eye disease is usually filtered out of my referrals by an optician.
Most people with headache or eye pain will see an optician long before they see a neurologist. Opticians are expert in detecting eye disease. Most General Practitioners will ask you to see an optician first if they suspect eye disease.
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