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Headache behind your eyes: Causes and treatment

Man suffering from headache due to eye pain

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What is a headache behind the eyes?

A headache behind the eyes is physical discomfort that's localized behind one or both eyes. The intensity of the pain can be mild or severe. A throbbing sensation may or may not accompany a headache behind the eyes. And despite the pain being felt behind the eyes, the cause of the headache may begin elsewhere.

A headache behind the eyes is often 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 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 says a general rule is that if there's no sign of red eyes and there are no visual complaints like blurred or distorted vision, it’s unlikely that the headache is related to an eye problem.

Causes of headache behind the eyes

Migraine

Migraine headache is the most common type of headache behind the eyes. A migraine headache typically is unilateral, which means it affects only one side of the head. It can cause severe throbbing pain behind the left or right eye (but usually not behind both eyes). Because of its location, a migraine headache is sometimes called an "eye headache."

Migraine headaches can last up to 72 hours and sometimes spread to the back of the head. Other classic symptoms of migraine headaches include nausea 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. But the majority of migraine sufferers experience headache pain behind the right or left eye with no migraine aura.

There are many migraine triggers. These include:

  • Fatigue

  • Emotional stress

  • Lack of sleep or oversleeping

  • Skipping meals

  • Bright or flickering lights

  • Strong odors

  • Loud noises

  • Certain foods

  • 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.

Cluster headaches

A cluster headache is a condition characterized by frequent attacks of short and extremely painful headaches. These cluster periods can last weeks or months, and are then followed by a remission period wherein 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

  • Watery eyes

It's 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.

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.

Graves' disease

Graves' disease is an autoimmune eye disorder associated with abnormalities of the thyroid gland. Signs and symptoms of Graves' disease include:

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

Eye conditions associated with headache behind eyes

There also are a few eye conditions 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, see an eye doctor immediately.

Scleritis

Scleritis is a severe inflammation of the sclera, or outer coating of the eyeball. It typically is caused by autoimmune disorders. Symptoms include:

  • Headache behind the eye

  • Red or pink eye

  • Excessive tearing

  • Blurred vision

  • 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.

Treatment of headache behind eyes

The best treatment for headache behind the eyes depends on the underlying cause.

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.

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 these headaches behind the eyes.

To determine the best treatment and prevention measures for a headache behind your eyes, see your optometrist or ophthalmologist. In some cases, your eye doctor may refer you to a neuro-ophthalmologist for a definitive diagnosis and treatment plan.

READ MORE: How to get rid of a headache

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