1. Headache
Dr shinisha paul

2. epidemiology
8% serious complications
1% life threatening

3. history Location Intensity Aggravating / relieving factors
Previous history
Systemic illness

4. Type of pain Throbbing : migraine
Pressure / tighteness : tension headache
Explosive / excruciating : cluster headache

6. examination
Systemic
Neurological
Psychiatric
Ocular

7. Ocular examination Vision – with PH, colour vision
Extra ocular movements – cranial nerve palsy
Pupillary reaction
Fundus examination – papilloedema, optic neuritis
Visual fields – glaucoma , neurological defect

8. migraine
Brainstem neuronal hyperexcitability
With aura / Without aura

10. Ocular causes of headache
Ocular migraine
- Cluster headache : commen in men, unilateral, sharp stabbing eye pain, several episodes over 24 hrs, each episode lasting from minutes to 2 hrs, 5th CN distribution, 30% have horners syndrome. Treatment : high flow O2, sumatriptan, prednisolone

12. - Ophthalmoplegic migraine : cranial nerve palsy, Diplopia and U/L headache

13. - Classical migraine : visual aura with scintillating scotoma

14. Basilar artery migraine

15. 2. Refractive errors 3. Accomodative spasm : hypermetropia 4
2. Refractive errors 3. Accomodative spasm : hypermetropia 4. Acute iridocyclitis : frontal headache and eye pain due to ciliary muscle spasm

16. 5. Acute congestive glaucoma - sudden onset of eye pain radiating to head, ear, teeth and sinus - blurred vision, coloured haloes, scotoma -signs : congestion, cloudy cornea, fixed pupil, raised IOP

18. 6. Posterior scleritis - T sign

19. 7. Herpes zoster ophthalmicus - unilateral headache prior to lesions - vesicular eruptions along ophthalmic division of 5th nerve

20. 8. Optic neuritis - headache with eye pain - defective vision - RAPD

21. 9. Ocular trauma - raised IOP - ciliary spasm

22. 10. intraocular/ intraorbital tumors

23. 11. Orbital cellulitis

24. 12. Lacrimal gland tumors

25. 13. Lid infections - blepharitis - hordeolum

26. 14. Corneal ulcers

27. 15. Papilloedema - transient blurring of vision - bilateral disc edema - raised ICT

28. 16. Giant cell arteritis - unilateral headache worse at night - commen in women - affects small and medium sized vessels - Diagnosis : ESR, CRP, Temporal artery biopsy

29. Red flag signs New onset headache > 50 yrs of age
Headache associated with nausea, vomiting
Worsens with Valsalva
Jaw claudication
LOC
Trauma

30. conclusion Headache is a common and challenging complaint
Proper diagnosis is mandatory
CT/MRI if required
OPHTHALMIC EXAMINATION IS
COMPULSORY

31.
THANK YOU
- OVER TO ENT