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Archive for November, 2009

headacheI started off wanting to write a simple article on headaches, and now I have one, a headache that is. All joking aside, the topic of headaches is very complex because there are so many different types, causes and treatments for headaches. There are many different reasons you may be experiencing aches and pains in the head or even in and around the eyes. If you are experiencing frequent headaches, a complete eye examination in addition to a full and thorough evaluation with your family doctor is helpful in accurately diagnosing the problem. Once you know the cause, you are that much closer to relief. Even if the problem turns out to be unrelated to your eyes or vision, you have one more thing that you can check off your list of possible reasons for your headaches and that “rule-out” can prove to be very valuable.

“An eye examination is an important part of the headache evaluation.” (Source 1) Patients often come to me complaining of headaches, in or around the eyes. They, along with their family doctor, are trying to determine the source of their headache pain in order to properly diagnose any medical conditions that may be causing the problem. Sometimes headaches can be caused by “eye strain.” Eye strain is sort of a catch-all phrase which can mean there are problems with the eyes’ ability to focus when reading (accomodation), to accurately aim at the object of regard (alignment), to work together as a team giving depth perception/3-D vision (binocularity) or to see things clearly (refractive error, corrected for by prescription glasses). These are some of the things that your eye doctor will check for and help you correct. 

However, there are other more health-threatening factors that can induce eye pain and aches in or around the eyes therefore it is crucial to have extensive tests done in order to promptly determine the true source of the pain. There are things that can be going wrong with the health of the eyes or other parts of the body.  Your eye doctor will check your vision, as well as the health of the eyes usually through a dilated eye exam and may also suggest a peripheral vision or visual field test. Make sure they proactively communicate their results with your general physician and also suggest additional tests if indicated in order to contribute to your complete and thorough quality of care.

One of the most common topics under the category of headaches that I find myself explaining to patients is the mechanism of an ocular migraine. An ocular migraine (ophthalmic migraine) is an episode of “temporary vision loss or distortion in one eye, usually accompanied or followed by a headache.” (source 2) It is due to a tightening of the blood vessels in the head causing a restriction of blood (and oxygen) to areas of the brain. When the occipital lobe (part of the brain which processes vision) does not get enough oxygen it can cause visual symptoms and side effects, some of which are listed below. The re-dilation of these blood vessels about 20 minutes later is thought to be the cause of the actual pain involved with a person’s migraine.

Some of the visual symptoms you may experience during an ocular migraine are:

  • flashing lights/sparks in your vision which may radiate outwards over time
  • shimmering zebra stripes/zig zags of light 
  • temporary blurring of vision or “missing pieces”, black spots in your vision

(source 3)

These symptoms can last anywhere from about 5 to 20 minutes and may or may not be followed by an intensely painful migraine headache. Vision should return back to normal shortly after, it it does not, seek medical help immediately. Sometimes your doctor will have you keep a simple journal which will chronicle details about the headaches when they happen as well as the activities you did that day and food you consumed.  Migraines usually begin in the morning or some time during the day (it is interesting to note that many eye strain issues occur towards the end of the day or after long periods of reading, computer use, etc). If it is determined by your doctor that you are experiencing migraines it is good to know the triggers of  migraines so that you will be able to avoid them whenever possible.

Some triggers for migraines are:wine

  • stress
  • hormonal changes (as well as use of oral contraceptives)
  • alcohol consumption (red wine being a common trigger)
  • cheese
  • chocolate
  • meats preserved in nitrates
  • monosodium glutamate (MSG)
  • light (intense sunlight)
  • smoking

(source 3)

Talk to your doctors, they will work with you to find the source of your pain and to make sure it is not a serious and urgent health problem. Relief will be its way, so don’t delay. Get it checked out today!

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