Pain behind the eyes is a common symptom with migraines. While it may feel like the discomfort is arising from the eye, the pathophysiology of eye pain in migraines is more likely related to nerve sensitivity, blood vessel dilation and sensory overload.
Trigeminal Nerve Activation
During the headache phase of migraine, the trigeminal nerve is activated. The ophthalmic branch of the trigeminal nerve supplies the eyes. Therefore, activation of this nerve can result in the sensation of pressure behind the eye, sharp or throbbing eye pain and light sensitivity
Blood Vessel Dilation
During a migraine, blood vessels around the brain and eyes can dilate. This increases the blood flow through these vessels and is sensed as a throbbing sensation behind the eye.
Sensory Overload
Migraines often result in sensitivity to light, sound and motion. This sensory overload can sometimes result in eye pain as well.
Eye Pain Is Not Always Migraines
Pain behind the eye is not always caused by migraine. If you have eye pain, it is important to see a doctor to determine the cause of the eye pain, especially if the pain pattern seems unusual. Examples of other conditions that can mimic migraine eye pain include:
- Cluster Headache – A cluster headache presents as a severe stabbing pain. Typically, it is one sided, peaks quickly, occurs in cycles (or clusters) and is accompanied by tearing, injected eyes or drooping of the eyelids). These headaches are much more intense than migraines and are treated differently from migraines.
- Sinus Headaches – Inflammation or infection of the sinuses can result in a sensation of a deep pressure behind the eyes, nasal congestion and pain that is worse with forward leaning. Unlike migraines, sinus headaches often come with nasal symptoms and fever.
- Eye conditions that shouldn’t be missed – Eye conditions that cause pain include acute angle-closure glaucoma, uveitis and optic neuritis. With these conditions, you will not only have eye pain but you may also experience other vision related issues such as blurred vision, halos or vision loss. If you experience these symptoms, it is important to seek help early.
When To Seek Help?
If you experience sudden / severe eye pain, changes in vision, new headache pattern or symptoms that persist or worsen despite treatment, it is recommended to see your doctor. Dr Christopher Liu is a Senior Consultant Pain Specialist at Alleviate Pain Clinic. We see patients with various types of headache and facial pain disorders.
