NEURO OPHTHALMOLOGY, HEADACHES & MIGRAINE

Headache

Whenever one has a headache, the first thought that usually crosses one's mind is to get an eye test. So the ophthalmologist (eye specialist) is often consulted by patients of headache. In fact the relationship of the eyes and headache is two fold. Firstly eyes may be a cause of headache in many people due to faulty eye sight, improper glasses or fitting and also due to muscle imbalance between the two eyes, computer strain etc . Secondly and more importantly eyes are a windows to get the insight of what may be afflicting the body and causing a headache. Many cases of brain tumour, papilloedema ( increased fluid pressure in the brain ), high blood pressure etc. have been diagnosed for the first time by a well trained and vigilant ophthalmologist. Other more frequently occurring types of headaches are described below.

1. Tension headache also known as tension-type headache, is the most common type of primary headache. The pain can radiate from the lower back of the head, the neck, eyes, or other muscle groups in the body typically affecting both sides of the head. Tension-type headaches account for nearly 90% of all headaches. Various precipitating factors may cause tension-type headaches in susceptible individuals.

  • Stress: usually occurs in the afternoon after long stressful work hours or after an exam
  • Sleep deprivation, Irregular meal time (hunger)
  • Uncomfortable stressful position and/or bad posture
  • Eyestrain and stress in muscles of the back of neck

Migraine

2. Migraine is a more severe type of primary headache disorder characterized by recurrent headaches that are moderate to severe. Typically the headaches affect one half of the head, are pulsating or throbbing in nature and last from two to 72 hours. Associated symptoms may include nausea, vomiting, and sensitivity to light, sound, or smell. The pain is generally made worse by physical activity. Up to one-third of people have an aura : typically a short period of visual disturbance which signals that the headache will soon occur. Occasionally, an aura can occur with little or no headache following it.

  • Nearly 1 in 4 families have someone with migraine.
  • Amazingly, over 12% of the population - including children - suffers from migraine. That's more than diabetes and asthma combined!
  • About 18% of all women and 6% of men suffer from migraine.
  • Migraine is most common during the peak productive years, between the ages of 25 and 55.
  • Migraine tends to run in families. If one parent suffers from migraine, there is a 40% chance a child will suffer. If both parents suffer, the chance rises to 90%.
  • About 10% of school-age children suffer from migraine.
  • Half of all migraine sufferers have their first attack before the age of 12. Migraine has even been reported in children as young as 18 months old.

Migraines are believed to be due to a mixture of environmental and genetic factors. About two-thirds of cases run in families. Changing hormone levels may also play a role, as migraines affect slightly more boys than girls before puberty and two to three times more women than men. The risk of migraines usually decreases during pregnancy. The underlying mechanisms are not fully known. It is, however, believed to involve the nerves and blood vessels of the brain.

The diagnosis of migraine is quite evident by the patient's complaints and history in most cases, while in many cases it is diagnosed by a process of exclusion of other diseases. There is no one clinical or blood test to pinpoint the diagnosis of migraine. The tense, perfectionist personality of a migraine patient is familiar to most clinicians; however it may not be so evident in many others and migraine is well known to start in early childhood also. Of the many tell-tale signs of migraine, headache triggered off during periods of mental or physical stress is well known. It may be related to certain foods in some, while, travelling, sinusitis and eye strain have been found to be the triggering stress in many patients. The throbbing pain with running nose , watering eyes, nausea, flashing lights or stars in front of eyes, sinking feeling and the wish to lie in a quiet, warm and dark place is a feeling most migraine patients have gone through. Uncontrolled yawning with headache accompanied by nausea and retching or vomiting is the hallmark of migraine in many patients.

3. Sinusitis Headache

Many patients of sinusitis headache complain of a normal ( non-migrainous ) headache passing on to migraine headache if the triggering stress of sinusitis is not controlled at earliest.

Patients of migraine may have headache due to many other causes also and over time most of them learn to differentiate a migrainous from a non-migrainous headache. One may wait for a non-migrainous headache to pass off if one does not feel like having any medication for the same, while in the case of a migraine headache it is best to take appropriate medication at the onset of the headache or whenever the patient is sure that it is an attack of migraine. During an attack of migraine the patient is frequently unable to take any tablets due to the accompanying nausea and vomiting, in such cases the attack may linger on till it passes off on its own , or the headache decreases after vomiting in others. Some patients may need an injection of pain-killers if they are unable to take oral medication during the attack. Preventive medicines like flunarazine have proven to be quite useful but are of little help if taken only at the time of migraine. Ophthalmologic migraine is a less common but more severe type of migraine where is risk of loss of vision or other neurological deficit.

Doctors at our hospital besides doing a complete eye check up are also well versed with diagnosis and treating such causes of headache.

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