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Headache behind the eyes: Causes and treatment

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A headache behind the eyes is something most people experience at some point in their life. Symptoms include pain that originates in the sinuses or in back of the eye. Headache pain may or may not throb like a pulse.

When you experience a headache behind the eyes, you want relief. You also want answers.

What causes a headache behind the eyes? What can you do to alleviate the pain? Is a headache behind the eyes being caused by some vision issue?

Let's tackle that last question first.

The American Academy of Ophthalmology (AAO) defines “pain behind the eye” as "physical discomfort due to an eye disease or other condition." But AAO also says, "where you feel pain is not necessarily an indicator of what’s causing the pain."

In most cases, a headache behind the eyes is a type of referred pain — that is, pain that's perceived at a location other than the site where it originates. Referred pain is common because of the body's network of interconnecting sensory nerves that supplies many different tissues.

“Almost all structures in the head that are sensitive to pain refer the pain to the eye area,” says Dr. Mark W. Green, MD, professor of neurology at the Icahn School of Medicine at Mount Sinai Hospital in New York. “Just because the pain is in the eye it doesn’t mean the problem is in the eye. In fact, it rarely is.”

Green notes that one useful rule to keep in mind is that if the white portion of the eye (sclera) isn’t red and there are no visual complaints like blurred or distorted vision, it’s unlikely that the headache is related to an eye problem.

WHAT'S CAUSING THE HEADACHE BEHIND YOUR EYES? Ask an expert. Find an eye doctor near you and schedule an in-office appointment or virtual visit.

Common causes of headache behind eyes

Migraine

Migraine headache is the most common type of disabling headache. It is a periodic headache that lasts up to 72 hours and often produces severe, throbbing pain on one side of the head and behind the eye. Migraine headaches also can spread to the back of the head.

Other classic symptoms of migraines include nausea, vomiting and sensitivity to light, smells and sounds.

“Migraine came from the term ‘megrim’, which means sick headache. People with migraines get sick,” Green says. “We talk about the spectrum of migraine, which are multiple headache types. They feel different, but are still part of the spectrum of migraine.”

Visual disturbances like flashing lights or halos around light sources that are known as migraine aura may precede the headache pain. However, the majority of migraine sufferers do not experience migraine aura.

There are many migraine triggers. These include fatigue, emotional stress, lack of sleep or oversleeping, skipping meals, bright or flickering lights, strong smells, loud noises, certain foods and changes in heat and humidity.

There also appears to be a strong genetic link for migraines, with 70% of sufferers reporting at least one close relative who also has a history of migraines.

Migraines caught early enough may be successfully treated with non-prescription, over-the-counter painkillers, but several prescription medications are available for use both preventatively to reduce the number of attacks and the pain when a migraine headache starts.

A daily medication regimen may be needed to treat chronic migraines and prevent headaches behind the eyes.

Cluster headaches

A cluster headache is a condition characterized by numerous and frequent attacks of short and extremely painful headaches. These cluster periods can last weeks or months, and are then followed by a remission period when no headaches occur for months or years.

A cluster headache usually comes on quickly, sometimes with aura, and can last up to three hours. Symptoms include excruciating pain (often, a headache behind one eye) that may radiate to other parts of the face, head and neck; red and swollen eyes; and excessive tearing.

It is believed that abnormalities in the hypothalamus (the portion of the brain that controls many critical bodily functions) may be responsible for cluster headaches. There are no identified triggers and no cure for cluster headaches behind the eyes.

Treatment of cluster headaches focuses on decreasing the severity of pain, shortening the cluster period and preventing future attacks. Oxygen therapy, injectable triptans and local anesthetics are among the treatments of choice.

Sinus infections

The sinuses are air-filled spaces in the skull. They are located behind the nose, forehead and cheeks — and also behind the eyes. Infection of the sinuses (sinusitis) is a common cause of pain, including headaches behind the eyes.

Migraine headaches often are misdiagnosed as sinus headaches. Treatment for sinus headache involves resolving the underlying infection with prescription antibiotics and decongestants.

Eye conditions that cause headache behind eyes

Finally, there are a number of eye conditions and other problems that can cause headache behind the eyes. These include:

Glaucoma

Glaucoma is an eye disease that affects the optic nerve and causes peripheral vision loss, blurred vision, difficulty adapting to darkness and halos around lights.

A specific type of glaucoma called acute angle-closure glaucoma can cause nausea and severe headache behind the eyes. If you experience these symptoms, you should see an eye doctor immediately.

Scleritis

Scleritis is a severe inflammation of the sclera, or outer coating of the eyeball.

Most commonly caused by autoimmune disorders, symptoms include headache behind the eye, red or pink eye, tearing and blurred vision as well as light sensitivity.

Optic neuritis

Optic neuritis, or inflammation of the optic nerve, is associated with eye pain or headache behind the eye, blurred vision, loss of color vision, floaters, nausea and vision loss.

Graves' disease

Graves' disease is an autoimmune eye disorder associated with abnormalities of the thyroid gland. It is characterized by bulging eyes, eyelid retraction, limited ability to move the eyes, red or pink eye, double vision and vision loss.

In some cases, Graves' disease also can cause headache behind the eyes.

When to see an eye doctor

If you experience unusual headaches behind the eyes, don't take chances: See an eye doctor immediately.

Why?

If the white of your eye is discolored or you experience nausea or visual problems associated with the headache, these are signs and symptoms of an acute glaucoma attack that could cause permanent vision loss.

MIGRAINE, CLUSTER HEADACHE OR SOMETHING WORSE? Discover what's causing the headache behind your eyes. Find an eye doctor near you and book an appointment or virtual visit.

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