Good Hope, Heartlands, and Solihull Eye Clinics

Headache from the ophthalmologists view for professionals

David Kinshuck, from lectures


See    See.

4 simple features in the patient's history can accurately diagnose migraine, and therefore neuro-imaging is not needed. Migraine causes a POUNDING headache:


  • pulsating
  • duration 4-72 hours
  • Unilateral
  • Nausea
  • Disabling

CNS lesion a possibility

MRI needed

  • cluster type headache
  • abnormal CNS examination
  • ill-defined headache
  • headache with aura
  • headache aggravated by valsalva-like manoeuvre
  • headache with vomiting

Medication overuse headache

DTB 2010 Suspect this if the headache

  • occurs >15 days/month
  • after 3 months of anti-migraine drugs, analgesics, caffeine
  • they is often a primary headache such as migraine or tension headache
  • after use of these drugs for> 9 days/month
  • after 37 doses/month (ergots), 114 (analgesics)
  • days medication taken is more indicative than the actual number of doses
  • after months of use (ergots), more than a year (analgesics)
  • gets better after stopping the drugs after 1-4/weeks in 50% of patients
  • if the headache continues after stopping for 4 weeks then investigations are required
  • paracetamol more than 15 days a month
  • caused by paracetamol or ibuprofen


  • thunderclap headache
  • particularly age>40
  • neck pain or stiffness
  • raised blood pressure
  • loss of consciousness
  • vomiting
  • BMJ 2010   editorial    article


  • City Hospital...headache nurse Julie Edwards
  • IIH...Miss Susie Mollan, QE


Chronic ha

  • > 3months

Cluster headaches

Frequent headaches longer than 3 hours

  • >3 hours may be migraine, no autonomic features (these are cluster)
  • want to lie still ...migraine.


  • does not need to lie down, unlike migraine (dark room, lies down)

A case

  • Case 76y, tender temporal artery, high crp 17, treated
  • But pain was like an electric shock..hundreds  of times a day, and pain came with red eye and watering...autonomic headaches..
  • Cause in this case Superior cerebellar artery loop, lamotrigine treatment