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S. Wolfe; Characteristics of Patients Presenting With Ocular Pain. Invest. Ophthalmol. Vis. Sci. 2007;48(13):956.
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To assess the utility of neuroimaging in patients with normal neuro-ophthalmic examinations referred to a neuro-ophthalmology clinic for complaints of chronic isolated eye pain. We were also interested in the prevalence of primary headache syndromes in these patients, particularly medication overuse headache.
Charts of 125 consecutive patients with some form of head pain were reviewed to find patients meeting the criteria of having complaints of chronic eye with normal neuro-ophthalmic exams. Excluded were patients with primary complaint other than eye pain, and those with abnormalities on exam which would account for the pain. 44 patients were included in the final data. All examinations were performed by a single examiner in a standardized fashion.
52% of patients noted symptoms of headache on presentation. 65% of those with headaches on presentation had a prior history of headache. 7% had a history of closed head injury. 21% had a family history of migraine. 86% received imaging of some form either prior to or after presenting to the clinic. Of those who had imaging, 87% received MRI and 13% received CT. One patient declined imaging. None of those who received imaging had any results explaining the ocular pain. Diagnoses given to patients (overlapping) included: Migraine (38.6%), Primary Headache Syndrome (31.8%), Medication Overuse Headache (20.5%), Neuropathic Pain (18.2%), Primary Stabbing Headache (6.8%), Primary Facial Pain (4.5%), Refractive (4.5%), Presumed Medication Overuse Headache (4.5%), Cluster Headache (2.3%), Dry Eye (2.3%).
Primary headache syndromes, including migraine, were the most common cause of chronic isolated eye pain in patients with normal neuro-ophthalmic examinations. Medication overuse headache may be a contributing factor in many such patients. Imaging was of low yield in this population. Patients with isolated eye pain have primary headache syndromes that require treatment.
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