3. FACTS ABOUT HEADACHEâĻ
īĸ The brain & skull are not sources of headache pain.
īĸ Because they donot contain pain sensitive nerve
endings & it lacks pain receptors.
īĸ Ultimately the pain is
caused by disturbance of pain sensitive structures
around the head & neck.
4. SOURCES OF HEADACHE ~
Nerve endings in the âĻâĻâĻ.
īĸ Extra cranial structures~
īŧ Scalp
īŧ Face
īŧ Throat
īŧ Muscles of head
īŧ Blood vessels at the base of the brain,neck
īŧ Meninges
īŧ Sinus
īŧ Dental structures
īĸ Intra cranial structures~
īŧ Large arteries near circle of Willis
īŧ Great intra cranial venous sinuses
īŧ Parts of dura & dural arteries
īŧ Cranial nerves
5. CONTâĻ.
īĸ When any of these nerve endings are triggered by
īŧ Stress
īŧ Tension in the muscles
īŧ Inflammation
īŧ Infection
īŧ Uncorrected Refractive error
īŧ Raised pressure
īŧ Dilatation in the blood vessels in the head
---------an individual can have HEADACHE.
10. CONTâĻ
B.Organic Cause:
1.High IOP-Acute congestive glaucoma,POAG,PCAG
2.Ocular and Orbital Infection and Inflamation:
Endophthalmitis,Panophthalmitis,Orbital Cellulitis,
Uveitis,Scleritis,Keratitis..etc
3.Ocular and Orbital Injury/Chemical Burns.
4.Ocular,Orbital and Eyelid Malignent Tumour.
5.Ocular Vascular Anomalies
6.Ocular Cranial Nerves Anomalies/Palsy:
Optic Neuritis,
Papilloedema
11. MIGRAINE..
īĸ caused by disturbances in the central nervous system leading
to swelling of the blood vessels in the brain and severe pain.
īĸ Female >Male
īĸ More in Teenager or young adults
īĸ Familial disorder.
Causes:
īŧ Chocolate
īŧ Cheese
īŧ Alcohol
īŧ Pills
īŧ Fatty foods
īŧ Orange
īŧ Tomatoes
īŧ Onions
īŧ More journey
īŧ Menstruation
īŧ Over ExerciseâĻ.
12. CONTâĻ
SymptomsâĻ
īĸ Eyeache
īĸ Throbbing pain
īĸ Vomiting
īĸ Nausea
īĸ Attention loss
īĸ Irritation
īĸ Flashes of white or multicolored light (photopsia )
īĸ Formation of dazzling zigzag light (Fortification spectra)
īĸ Phonopsia
Headache in a temporal portionâĻ
13. TO GET RELIEF..
īŧ 8 hour sleeping
īŧ To avoid trigger facts
īŧ No stress,depression
īŧ Medication
(Fortification
spectra)
14. EVALUATION OF OCULAR BASED
HEADACHEâĻ.
1) History:
Chief complain---
īŧ Quality & location of the pain
īŧ When headache occurs ?
īŧ From when it started ?
īŧ How long it lasts ?
Associated history---
īŧ Eyeache
īŧ Blurring of vision
īŧ Nausea
īŧ Vomiting
īŧ Photophobia
īŧ Watering
15. CONTâĻ
īĸ Visual acuity
īĸ Extra ocular motility
īĸ Cover test
īĸ Near point of convergence
īĸ Near point of accommodation
īĸ AC/A ratio
īĸ Positive /Negative fusional vergence(near & distance )
īĸ Binocular single vision (near & distance)
īĸ Stereopsis (near & distance)
īĸ Refraction (cycloplegic)
19. NEAR POINT OF CONVERGENCE
īĸ [8-10]cm
īĸ Binocularly
īĸ With- Pen or RAF ruler
20. NEAR POINT OF ACCOMMODATION
īĸ (8-10/12)cm
īĸ Monocularly
īĸ RAF ruler
21. AC/A RATIO
īŽ Ratio of accommodative convergence of an
individual to a unit stimulus of accommodation
īŽ Unit = â/D
īŽ Normal range = 4 to 6
īĸ Value above 6 = excessive accommodative convergenc
īĸ Value below 4= Insufficiency
22. POSITIVE & NEGATIVE FUSIONAL VERGENCE
Positive fusional vergence
(base out prism)
īŧ Near-[30-45] PD
īŧ Distance â[16-20] PD
Negative fusional vergence
(base in prism)
īŧ Near â16PD
īŧ Distance-8PD