HEADACHE EVALUATION

Farhana AdninB.Optom,4th BatchICO,CU

WHAT IS HEADACHE…?What

is headach

e ???

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.

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

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.

CLASSIFICATION OF HEADACHE…(INTERNATIONAL HEADACHE SOCIETY)

1] Primary headache--- Migraine – with/without aura Tension headache Cluster headache Chronic daily headache Medication overuse

CONT….

2) Secondary headache--- Head injury Brain tumour Meningitis Raised BP Ear cause Sinus cause Dental cause Ocular cause…etc

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.

4.Accommodation Anomalies: Accommodation insufficiency-Excess

Reading in Young patient5.Convergence Anomalies: Convergence Insufficiency.6.Ocular Muscle Problem: Tropia/Phoria.7.Ocular Migraine.8.AC/A ratio9.Dry eye

CONT…

B.Organic Cause:1.High IOP-Acute congestive

glaucoma,POAG,PCAG2.Ocular and Orbital Infection and Inflamation: Endophthalmitis,Panophthalmitis,Orbital

Cellulitis, Uveitis,Scleritis,Keratitis..etc3.Ocular and Orbital Injury/Chemical Burns.4.Ocular,Orbital and Eyelid Malignent Tumour.5.Ocular Vascular Anomalies6.Ocular Cranial Nerves Anomalies/Palsy: Optic Neuritis, Papilloedema

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….

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…

TO GET RELIEF..

8 hour sleeping To avoid trigger facts No stress,depression Medication

(Fortification spectra)

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

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)

VISUAL ACUITY…

6mitre

LOGMAR

Snellen

EXTRA OCULAR MOTILITY…

COVER TEST…

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

NEAR POINT OF ACCOMMODATION

(8-10/12)cm Monocularly RAF ruler

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

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

FOR FUSION….

Bagolini striated glass

BINOCULAR SINGLE VISION….

For near….

CONT…

For distance

STEREOPSIS…

Titmus fly test with polarizing filter TNO random dot test

CONT…

synoptophore

CYCLOPLEGICREFRACTION…

OTHERS..

Intra ocular pressure Fundus examination CT Scan MRI

MANAGEMENT

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

SPECTACLE CORRECTION…

CONVERGENCE ANOMALIES…

Dot test Pencil push up test

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

FUSIONAL ANOMALIES…

catstereogram

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

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