Headaches Behind the Eyes – Triggers, Treatments and How to Prevent Them

Now that many people are working from home on a regular basis, there’s less regulation of working setups in terms of back support, distance from the screen, and comfortable space. Because of this, people may not be working under ideal conditions, making them more prone to headaches and general discomfort.

Headache queries usually formed roughly 80% of ‘the reason for visit’ for patients that I used to see in practice. When digging deeper into the headaches, the usual pattern was a dull ache which worsened as the day went on, or a pain that became more intense towards the end of the week across the front of the head and temples in particular. Looking further into this used to reveal the prolonged use of digital devices at work and at home.

Below are headaches affecting patients:

• Occipital Neuralgia
  Occipital neuralgia is a headache beginning in the upper neck or back of the head, moving behind the eyes and across the scalp, incorporating bursts of pain either with an ongoing headache or on their own.
  
  This type of headache often affects those prone to migraines, and is as a result of irritation or injury of the occipital nerves. Symptoms can include sensitivity to light, and movement can cause additional pain.
  
• Cluster headaches
  Cluster headaches are a series of brief headaches over the course of a single day, usually on one side of the head. These can be very painful and may manifest additional symptoms, including red eyes or tearing, as well as sweating, skin flushing, and congestion issues.
  
  I had a patient who had, over a period of time, episodes where he kept being woken up by an intense pain behind and around one eye. He also had an associated red and watery eye. On further questioning I noted that it would occur at the same time each night. These are typical symptoms of a cluster headache.
  
  Results typically come back normal and can be treated by a pain reliever.
  
• Frontal lobe headaches
  Frontal lobe headaches manifest as mild to severe pain in the forehead or temples, and can occur as a result of stress.
  
  However, there are a wide range of causes of frontal headaches, including infections, dehydration, poor posture, or eye strain - in which eyes constantly focused on a screen can become fatigued.

Uncommon eye issues from headaches

Not all headaches are isolated symptoms. Some may be indications of wider issues and it’s important to consult with your doctor or optometrist if you manifest additional symptoms.

These diagnosis include:

• Anterior uveitis
  Anterior uveitis is a form of uveitis, in which inflammation occurs in the uvea, part of the eye. It usually begins slowly, over several hours or days, resulting in eye redness and pain in or around the eye, sensitivity to light, and possible blurry vision - usually focused on one eye.
  
  If you believe that you are experiencing these symptoms, you should visit your optometrist or a hospital immediately.
  
• Optic neuritis
  Optic neuritis occurs when inflammation damages the optic nerve. You may experience loss of vision in one eye and in specific fields of view, as well as color vision loss. An ache behind the eye usually develops and may be worsened by eye movement.
  
  It can be a result of several different diseases, particularly multiple sclerosis, so if you feel you’re experiencing any of the symptoms, you should review with your optometrist as soon as possible.
  
• Glaucoma
  Acute angle-closure glaucoma may occur suddenly and without warning. Symptoms may include nausea and vomiting, as well as severe head and eye pain and vision loss. You may experience blurred vision and the sudden appearance of rainbow-colored circles around bright lights.
  
  If you experience these symptoms, you should immediately contact an ophthalmologist to minimize damage as quickly as possible.
  
• Papilloedema
  Papilloedema is a swelling of the optic nerve, due to raised intracranial pressure, that may initially have no symptoms, but in which vision problems and headaches are likely to develop over time, along with nausea. It can be a result of injury, or as a result of conditions including brain tumours, so regular eye exams are vital to identify papilloedema as early as possible.
  
  Lack of treatment of the papilloedema may eventually lead to vision loss.
  
  I remember a patient with severe headaches on waking. This immediately rang alarm bells – headaches on waking usually, but not always, indicate an underlying issue, as your eyes are well rested before the start of the day. I asked him to rate his headache on a scale of 0-10, and he did not even have to think about it – it was a 10. The severity of the headache was also ringing alarm bells. His vision was poor, and when I assessed the back of the eyes, I noted swelling of both optic nerves (papilloedema). This is usually brought on by raised intracranial pressure which may indicate a lesion on the brain.
  
  He was referred urgently to hospital and diagnosed with a brain tumor.
  
• Temporal arteritis
  Temporal arteritis is a form of inflammation of the blood vessel walls leading to constrictions in arteries. It can be identified by a constant severe, throbbing, and burning pain in the temples that can worsen when touching the area. This pain is usually noticed by patients when brushing their hair.
  
  The pain is most often on one side of the head and may be accompanied by fatigue, fever, loss of weight, and possibly aching in the jaw muscles.
  
  In some cases, the artery supplying the retina can become completely blocked, which can lead to vision loss, while a blockage leading to the brain can cause a stroke. Consult with a medical professional as early as possible to begin treatment.
  
• Migraines and the eyes
  Migraines are a specific and severe form of headache accompanied by additional symptoms, such as nausea, vomiting, and increased sensitivity to light and sound.
  
  There are different types of migraines including “migraines with aura,” in which the migraine is preceded by effects such as flashing lights in vision, blind spots, or other changes in vision in both eyes.
  
  The most common types are “migraines without aura” that provide no specific warning sign. The third type of migraines is “migraine aura without headache”, which is where patients can experience the symptoms of a migraine without the headache itself.

Treating headaches behind the eyes
While many general headaches can be treated with painkillers and over-the-counter medication, it’s best to take steps to prevent them before they arrive, particularly if you find yourself regularly experiencing headaches that aren’t as a result of a wider medical problem.

There are a number of ways to prevent and treat headaches:

• Regular sleep - Irregular sleep patterns, including lack of sleep and oversleeping, can cause headaches. Six to eight hours of sleep every night, starting and finishing at the same times, is ideal.
• Physical activity - Physical exercise providing fresh air can assist with keeping the body functioning properly.
• Physical posture - The position of the spine can affect nerves and cause headaches. Support for the lower back is recommended, as well as regular breaks and stretching.
• Comfortable setup and breaks - Screens should be positioned 50-100cm from the face, both to prevent leaning at a poor angle and to reduce eye strain and fatigue - but you should still take regular breaks every 20 minutes to look at something at least 20 feet away for at least 20 seconds.
• Hydration - Dehydration is one of the most common causes of headaches. Regular drinking of water can help prevent headaches as well as eye dryness.
• Medication - General headaches can be treated with over-the-counter painkillers. If you regularly have migraines, you may wish to talk to your doctor about prescription options such as triptans.
• Rest - Simply lying down in a dark and quiet room can sometimes help alleviate symptoms until the headache or migraine passes.
• Massage - Light massage can help reduce some of the tension that contributes to migraine pain in particular.
• Compresses - Warm or cold compresses applied to the head and neck can sometimes relieve some of the pain involved in a headache or migraine.
• Eye tests - An incorrect prescription for your contact lenses or glasses can lead to eye strain and cause headaches. Ensure you regularly visit your optician to keep your prescription up to date.

Headaches may appear for a very wide range of reasons and are usually completely harmless beyond the pain inflicted. If you do encounter any symptoms out of the ordinary you should report it to a medical professional.

Roshni Patel BSC (Hons) MCOptom is an Optometrist and the Professional Services Manager at Lenstore. Patel is passionate about exploring efficiency in Optometry through the use of technology and is currently involved in research and innovation, both within and outside of the optical sector.