An intense pain behind our eyes is not something we haven’t experienced. From prolonged use of phones, watching TV, or reading in poor lighting to conditions like sinusitis, many factors can lead to pain behind the eye, also known as retro-orbital headache. Those who suffer from migraine can also be subject to discomfort behind their eyes. But how do we know what’s causing the condition? What are the things that we need to consider? What are the characteristics of a migraine that can help confirm the diagnosis? Speaking with the OnlyMyHealth team, Dr Natasha Tipnis, Consultant Neurologist, Jaslok Hospital and Research Centre, Mumbai, helps answer all these queries.
Understanding Retro-Orbital Headache And Its Common Causes
Retro-orbital headaches, also known as pain behind the eyes, are headaches that cause discomfort or pain in and around the eye sockets. These can often be described as a deep, aching, or pressure-like sensation.
To understand the underlying causes of pain behind the eyes, Dr Tipnis advises to first classify the headache based on the following questions:
- Is the pain in only one eye or both?
- Is it associated with redness and/or watering from the eye?
- Is it associated with any difficulty in vision?
- Is it associated with double vision or obvious deviation of the eye?
- Is it associated with pain on the forehead or cheek or any other region?
While migraine, cranial neuralgias, sinusitis, tension headache, and dengue fever are some of the common causes of retro-orbital headache, depending on the location of the pain, involvement of one or both eyes, and associated symptoms, the causes can be wide-ranging.
For instance, pain behind just one eye could mean cluster headache or trigeminal autonomic cephalgias, which are not associated with any difficulties with vision, says Dr Tipnis, adding, “When the pain is associated with a difficulty in vision, it indicates involvement of the optic nerve, the nerve which carries the sense of vision to the brain.”
Additionally, if the pain is associated with double vision, it could indicate involvement of the nerves which supply the muscles that move the eyes. This could indicate conditions like cavernous venous sinus thrombosis, a blood clot in the cavernous sinuses, which can be life-threatening, as per the UK National Health Services (NHS).
Is Pain Behind Your Eyes Migraine?
Finding out whether pain behind the eyes is due to a migraine can be challenging, but there are some characteristics and associated symptoms that can help.
- Most migraine headaches often cause pain on one side of the head, and this pain can extend to the area behind one or both eyes, says Dr Tipnis.
- Usually migraines are described as a throbbing or pulsating pain that can be moderate to severe in intensity.
- Migraines can be accompanied by nausea and vomiting.
- Migraine is triggered by exposure to bright sunlight or any other bright, flashing lights.
- Similar to light sensitivity, sounds can heighten migraine symptoms, leading to phonophobia.
- Some individuals with migraines experience visual disturbances called auras, which can include seeing flashing lights, zigzag lines, or temporary vision loss.
- Migraine attacks can last anywhere from a few hours to several days. Duration can also tell a lot about what you're suffering from.
Dr Tipnis warns against the strong triggers that lead to migraine attacks, which include lack of sleep, lack of proper hydration, fasting for long periods, exposure to harsh sunlight or harsh lights or flashing lights, certain food items like dark chocolate and wine.
"Migraine headaches begin with a low intensity and gradually increase in intensity over time. They are known to be stereotypical in patients with a prior history," she adds.
How To Manage Pain During A Migraine Attack
Migraine is a common condition that affects an estimated 12% of the global population, with 1-2% suffering from chronic migraine, as per a study published in the Journal Neurologic Clinics.
Another study published in the Journal Frontiers in Neurology reports that the global prevalence of migraine has increased substantially over the last three decades, citing the Global Burden of Disease (GBD) 2019 study, which says the estimated global prevalence of migraine increased from 72.19 crore in 1990 to more than 100 crore in 2019.
It is quite evident from the above-mentioned data that a huge population of people suffer from the condition. Having said that, it is important to be aware of pain management techniques.
According to Dr Tipnis, the most important step in management of pain is to move the patient away from a trigger that is known to have caused the migraine and place the individual in a dark, quiet room, as patients with migraine get worse with harsh lights and loud sounds.
“The second step is to immediately administer the treatment for acute attack. This could be an NSAID like Naprosyn which may be used for a milder attack or a Triptan like Rizatriptan which is indicated for more severe migraine and migraine known to be resistant to NSAIDs,” the doctor says, adding, “Most of the medications for acute migraine do not work if given more than half an hour after the attack.”
Moreover, proper hydration is key and patients should be made to rest for a while, the doctor concludes.
