Ophthalmic Causes Of Headache

7,896 views

Published on

Talk on Ophthalmic causes of head ache.

Dr Ashish Mahobia M.S.,F.R.F.,F.N.B.

Consultant Eye surgeon and Vitreo retinal specialist

Sai baba Eye hospital & retina centre.,Near chhoti line ,Fafadih , Raipur , Chattisgarh,India.PIN 492001 .Phone 0771 - 4037979 ,4025063,Mobile:+91-9329117979

2 Comments
22 Likes
Statistics
Notes
No Downloads
Views
Total views
7,896
On SlideShare
0
From Embeds
0
Number of Embeds
277
Actions
Shares
0
Downloads
326
Comments
2
Likes
22
Embeds 0
No embeds

No notes for slide

Ophthalmic Causes Of Headache

  1. 1. Ophthalmic causes of Headache Dr Ashish Mahobia. MS;FRF;FNB Sai Baba Eye hospital,Raipur
  2. 2. Lets probe deeper <ul><li>Ophthalmic </li></ul><ul><li>Non ophthalmic </li></ul>
  3. 3. <ul><li>Ophthalmologists are usually the first doctors to see a patient of headache </li></ul><ul><li>Some headaches are symptoms of medical emergencies . </li></ul>
  4. 4. Good History taking <ul><li>“ Listen to the patient,He is telling you the diagnosis” - Dr William Osler </li></ul><ul><li>We interrupt in 30 secs* </li></ul><ul><li>Headache (primary c/t?) </li></ul><ul><li>Mild / mod /severe - Is it debilitating? (subjective) </li></ul><ul><li>* Svab I. The time used by the patient when he/she talks without interruptions. Aten Primaria 1993;11: 175-7. </li></ul><ul><li>Blau JN. Time to let the patient speak. BMJ 1989;298: 39. </li></ul>
  5. 5. Severe Headache <ul><li>Half sided (HemiKrania=Migraine) ? </li></ul><ul><li>Photophobia/phonophobia/scintillating scotoma/nausea? </li></ul><ul><li>Association - near work </li></ul><ul><li>stress ,travel </li></ul><ul><li>aur …aur…aur…aur..aur </li></ul>
  6. 6. Severe Headache… <ul><li>Remember!! </li></ul><ul><li>Migraine with aura (Classical migraine) </li></ul><ul><li>only 10-35% </li></ul><ul><li>Migraine and without aura > 50% (Common migraine) [1] </li></ul>
  7. 7. Severe Headache… Ask to point out with finger(Head/face/eye/neck)
  8. 9. Complete examination is MUST <ul><li>Systemic/neurological </li></ul><ul><li>Psychological analysis (Non verbal clues) </li></ul><ul><li>Vision </li></ul><ul><li>Motility </li></ul><ul><li>Pupils </li></ul><ul><li>Fundus </li></ul><ul><li>Field defects </li></ul>
  9. 10. All Ocular pathologies <ul><li>Referred headache </li></ul><ul><li>ACG </li></ul><ul><li>Retro bulbar neuritis </li></ul>
  10. 11. Vision.. <ul><li>Uncorrected refractive error </li></ul><ul><li>Untreated hyperopia/Presbyopia </li></ul><ul><li>Overcorrected Myopia </li></ul><ul><li>Use Jacksons cross cylinders/Auto ref </li></ul><ul><li>Accommodative spasm (eye pain, myopia, and miosis) </li></ul><ul><li>20/20 vision doesn’t mean “No glasses” </li></ul>
  11. 12. Refraction tips <ul><li>Correct cylcloplegic </li></ul><ul><li>Relax accomodation in A refractometer </li></ul><ul><li>Myopics:Do the ‘Duochrome” test (each eye) </li></ul><ul><li>High power glasses in last cell of trial frame </li></ul><ul><li>See for pantascopic tilt </li></ul>
  12. 13. Tips for refraction… <ul><li>Undercorrect Myopes (Sply high minus) </li></ul><ul><li>Do not overcorrect H metropes </li></ul><ul><li>Reduce quarter of Cylindrical power </li></ul><ul><li>Graded wear/increase of Cylindrical power </li></ul><ul><li>(except pseudophakes) </li></ul>
  13. 14. Near correction <ul><li>“ Jitni door se hamesha kaam karte hain” </li></ul><ul><li>Move it away…(see the needs and occupation) </li></ul><ul><li>Do not change the type of bifocal segment </li></ul><ul><li>Do not change the axis which has been used for years </li></ul><ul><li>Do not change a comfortable refraction just because your autoref says so </li></ul><ul><li>Don’t over believe in autorefs/optometrists </li></ul>
  14. 15. See the IPD <ul><li>Prismatic effect </li></ul><ul><li>Ensure good centration </li></ul><ul><li>Sply Large power </li></ul><ul><li>Children </li></ul><ul><li>Large heads </li></ul><ul><li>Spectacle /Frame change </li></ul><ul><li>Anisometropia (walk around test) </li></ul>
  15. 16. Strabismus <ul><li>Latent </li></ul><ul><li>Manifest </li></ul><ul><li>All gaze positions </li></ul><ul><li>Near and distance </li></ul>
  16. 17. Convergence deficiency <ul><li>Orthophoria for distance and exophoria for near show </li></ul><ul><li>Primary/H metropia/Myopia/presbyopia </li></ul><ul><li>NPC: Normal 8 cms </li></ul><ul><li>“ Pencil push up” </li></ul><ul><li>Over minus and less plus </li></ul><ul><li>Base in prism/bifocals. </li></ul>
  17. 18. Responsibility…
  18. 19. Thank you! Wish you and the whole family a V Prosperous & Joyous Diwali!
  19. 20. <ul><li>Activation of the trigeminal autonomic reflex arc also accounts for Holmes adie pupil on the symptomatic side. </li></ul><ul><li>Eyelid edema, redness, lacrimation, or nasal congestion, during the migraine attacks are more likely to respond to sumatriptan, a serotonin receptor agonist. </li></ul>
  20. 22. Cluster headache , also known as histamine headache <ul><li>severe and unilateral typically are located at the temple and periorbital region. </li></ul><ul><li>Associated with ipsilateral lacrimation, nasal congestion, conjunctival injection, miosis, ptosis, and lid edema. </li></ul><ul><li>Each headache is brief in duration, typically lasting a few moments to 2 hours. Cluster refers to a grouping of headaches, usually over a period of several weeks. </li></ul><ul><li>To fulfill criteria for diagnosis, patients must have had at least 5 attacks occurring from 1 every other day to 8 per day and no other cause for the headache. </li></ul>

×