1. HEADACHE EVALUATION
Farhana Adnin
B.Optom,4th Batch
ICO,CU

2. WHAT IS HEADACHE…?

3. FACTS ABOUT HEADACHE…
 The brain & skull are not sources of headache pain.
 Because they donot contain pain sensitive nerve
endings & it lacks pain receptors.
 Ultimately the pain is
caused by disturbance of pain sensitive structures
around the head & neck.

4. SOURCES OF HEADACHE ~
Nerve endings in the ……….
 Extra cranial structures~
 Scalp
 Face
 Throat
 Muscles of head
 Blood vessels at the base of the brain,neck
 Meninges
 Sinus
 Dental structures
 Intra cranial structures~
 Large arteries near circle of Willis
 Great intra cranial venous sinuses
 Parts of dura & dural arteries
 Cranial nerves

5. CONT….
 When any of these nerve endings are triggered by
 Stress
 Tension in the muscles
 Inflammation
 Infection
 Uncorrected Refractive error
 Raised pressure
 Dilatation in the blood vessels in the head
---------an individual can have HEADACHE.

6. CLASSIFICATION OF HEADACHE…
(INTERNATIONAL HEADACHE SOCIETY)
 1] Primary headache---
 Migraine –
with/without aura
 Tension headache
 Cluster headache
 Chronic daily
headache
 Medication overuse

7. CONT….
 2) Secondary headache---
 Head injury
 Brain tumour
 Meningitis
 Raised BP
 Ear cause
 Sinus cause
 Dental cause
 Ocular cause…etc

8. OCULAR CAUSES OF HEADACHE…
Functional Cause:
1.Eye Strain: Cilliary Muscle Stressed, Overworked.
2.Refractive Error:
Un-corrected Astigmatism
Un-corrected Hypermetropia
Un-corrected Presbyopia.
Over Corrected Myopia
Over-Corrected Presbyopia
3.By Spectacles:
Wrong Power in Spectacles, Wrong IPD,Improper
Centration of Glass.

9. 4.Accommodation Anomalies:
Accommodation insufficiency-Excess Reading in Young
patient
5.Convergence Anomalies:
Convergence Insufficiency.
6.Ocular Muscle Problem:
Tropia/Phoria.
7.Ocular Migraine.
8.AC/A ratio
9.Dry eye

10. CONT…
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..
 caused by disturbances in the central nervous system leading
to swelling of the blood vessels in the brain and severe pain.
 Female >Male
 More in Teenager or young adults
 Familial disorder.
Causes:
 Chocolate
 Cheese
 Alcohol
 Pills
 Fatty foods
 Orange
 Tomatoes
 Onions
 More journey
 Menstruation
 Over Exercise….

12. CONT…
Symptoms…
 Eyeache
 Throbbing pain
 Vomiting
 Nausea
 Attention loss
 Irritation
 Flashes of white or multicolored light (photopsia )
 Formation of dazzling zigzag light (Fortification spectra)
 Phonopsia
Headache in a temporal portion…

13. TO GET RELIEF..
 8 hour sleeping
 To avoid trigger facts
 No stress,depression
 Medication
(Fortification
spectra)

14. EVALUATION OF OCULAR BASED
HEADACHE….
1) History:
Chief complain---
 Quality & location of the pain
 When headache occurs ?
 From when it started ?
 How long it lasts ?
Associated history---
 Eyeache
 Blurring of vision
 Nausea
 Vomiting
 Photophobia
 Watering

15. CONT…
 Visual acuity
 Extra ocular motility
 Cover test
 Near point of convergence
 Near point of accommodation
 AC/A ratio
 Positive /Negative fusional vergence(near & distance )
 Binocular single vision (near & distance)
 Stereopsis (near & distance)
 Refraction (cycloplegic)

16. VISUAL ACUITY…
6mitre
LOGMAR
Snellen

17. EXTRA OCULAR MOTILITY…

18. COVER TEST…

19. NEAR POINT OF CONVERGENCE
 [8-10]cm
 Binocularly
 With- Pen or RAF ruler

20. NEAR POINT OF ACCOMMODATION
 (8-10/12)cm
 Monocularly
 RAF ruler

21. AC/A RATIO
 Ratio of accommodative convergence of an
individual to a unit stimulus of accommodation
 Unit = ∆/D
 Normal range = 4 to 6
 Value above 6 = excessive accommodative convergenc
 Value below 4= Insufficiency

22. POSITIVE & NEGATIVE FUSIONAL VERGENCE
Positive fusional vergence
(base out prism)
 Near-[30-45] PD
 Distance –[16-20] PD
Negative fusional vergence
(base in prism)
 Near –16PD
 Distance-8PD

23. FOR FUSION….
Bagolini striated glass

24. BINOCULAR SINGLE VISION….
For near….

25. CONT…
For distance

26. STEREOPSIS…
Titmus fly test with polarizing filter TNO random dot test

27. CONT…
synoptophore

28. CYCLOPLEGIC
REFRACTION…

29. OTHERS..
 Intra ocular pressure
 Fundus examination
 CT Scan
 MRI

30. MANAGEMENT
Medication for ocular based headache
For migraine~
 Flunarizine 5mg/10mg
 Pizotrifen 0.5/1.5 mg
 Beta blockers –propranolol
 Anti depression tablet.
Others….
 NSAID’s

31. SPECTACLE CORRECTION…

32. CONVERGENCE ANOMALIES…
 Dot test
 Pencil push up test

33. ACCOMMODATION ANOMALIES…
 Brock string
 Flippers
 Hart chart test
(near & distance )

34. FUSIONAL ANOMALIES…
catstereogram

35. REFERENCES….
 Encyclopedia of diseases & disorders
-Rebecca J. Frey
 Clinical methods
-H.Kenneth Walker
-W.Dallas Hall
-J.Willis Hurst
 Essentials of ophthalmology
-Samar K. Basak
 Clinical management of strabismus
-Elizabeth E. Caloroso
-Michael W.Rouse
 Clinical orthoptics
-Fiona J.Rowe
 Anatomy & Physiology of Eye
- A.K.Khurana
 Websites