Headache and the eye.

PURPOSE OF REVIEW: Visual disturbances and ocular symptoms are common manifestations of two primary headache disorders, migraine and trigeminal autonomic cephalalgias, and many secondary headache disorders.

RECENT FINDINGS: Structural lesions have been described with trigeminal autonomic cephalalgias. A systematic diagnostic evaluation including neuroimaging with assessment of intracranial and cervical vasculature, and the sellar and paranasal regions is recommended in every patient presenting with symptoms indicative of trigeminal autonomic cephalalgias for the first time.

SUMMARY: Ophthalmologists are often the first physicians to evaluate patients presenting with headaches and ocular pain or visual symptoms. Knowledge of primary and secondary headache disorders, a detailed history, and a thorough clinical examination are prerequisites for accurate diagnosis and appropriate management.