It’s often said the brain is an extension of the eye, and for that reason a headache may be a symptom of an vision problem. Headaches that are related to the eye can be of the forehead, temples, behind the eyes, and at the back of the skull. They may be excruciating or dull. They may or not be alleviated by Tylenol or sleep. They may even present with blurred vision.
If you are having headaches with blurry vision, your eye doctor may ask you the following questions:
- Where do your headaches occur?
- Do you wake up with headaches? Do they worsen with near work?
- How long does your vision stay blurry when you have the headache?
- If you were to grade the severity of the headache on a 1-10 scale, what number would you give?
Here are the 8 most common reasons for headaches combined with blurry vision, and how they are diagnosed and treated.
1. Accommodation
Accommodation is the ability of the lens and muscles of the eye to focus on a near object. The lens adjusts in shape to view things at different distances. It takes more effort to accommodate when looking at your phone or a laptop than to view your TV.
Accommodation is a common cause of headaches in computer users or those around the age of 40. A headache that occurs as the day progresses after computer or digital device work and affects the front of the skull or behind the eyes is mostly like caused by accommodation.
Headaches caused by accommodation can be resolved with the proper correction in glasses or contact lenses. I often tell my patients it is like lifting weights. If you lift weights all day, your arms will be tired, similarly if your eyes are working overtime, a prescription for reading can be used to do the work for your eyes so they may relax.
2. Binocular vision disorder
A binocular vision disorder occurs when the eyes don’t align properly, and the brain tries to make corrections. There are several types of binocular vision disorders including:
- Amblyopia
- Constant or intermittent strabismus
- Disorders of maintaining horizontal eye alignment (convergence insufficiency, convergence excess, divergence insufficiency, divergence excess) and vertical heterophoria
Binocular vision disorders present with a wide range of symptoms including headache, blurry vision, and ocular pain. Research demonstrates those with migraine headaches are more likely to have a binocular vision disorder. An eye doctor trained in binocular condition can perform specialized testing to confirm the diagnosis and prescribe appropriate treatment.
3. Sinusitis
There are four pairs of sinuses: maxillary, frontal, ethmoidal, and sphenoid.
These sinuses are located around and behind your eyes and can often cause a headache and eye pain. Often, sinusitis results in pain when you move your eyes or increased pain when you bend to pick something up. Many patients report blurry vision which may be from the sinusitis or more likely, OTC medications. Sinusitis presents most often when seasons changes and may be the cause of a dull headache lasting around two weeks.
Sinusitis can often be treated with oral antibiotics.
4. Ocular migraines
An ocular or retinal migraine is a temporary loss of vision for around 30 minutes to an hour. Vision will then recover to pre-migraine levels. The most common symptoms reported include flashes of bright light, “foggy” vision, zigzag lines, dark hole, small bright dots, and vision appears “like looking through heat waves or water.” The condition may or may not present with a headache. Ocular migraines are considered rare but are likely under-recognized.
There is no current treatment for ocular migraines.
5. Pseudotumor cerebri
Pseudotumor cerebri means false brain tumor. The condition results in swelling of the optic nerve and is likely due to high pressure within the skull caused by the buildup or poor absorption of cerebrospinal fluid (CSF). It is most diagnosed in women between the ages of 20 and 50.
Common symptoms of pseudotumor cerebri include headache, nausea, blurred vision, vomiting, and pulsating sounds within the head. This headache feels like “the worse headache” you have ever had. Pseudotumor cerebri is often diagnosed from an eye exam because it causes your optic nerve margins to appear blurred causing blurry vision.
This condition is considered an emergency and the patient will be sent immediately to the ER.
6. Hypertensive retinopathy
Hypertensive retinopathy is a disease of the retina which may result in vision impairment or vision loss due to systemic hypertension. Elevated high blood pressure in the body over a period of time, without treatment, can result in the breakdown of the tiny blood vessels in the back of the eye resulting in bleeding, retinal swelling, optic nerve swelling and intense headaches, and vision-threatening eye conditions like retinal vascular occlusion, retinal macroaneurysm and non-arteritic anterior ischemic optic neuropathy.
Much is still unknown regarding the relationship between hypertension and headaches. NIH research published on pubmed.gov has established a link, but it is complex and multifactorial.
7. Pituitary tumor
A pituitary tumor is a common, benign tumor of the pituitary gland. 1 in 10 people will develop a pituitary tumor in their lifetime, according to Hopkins Medicine. Systemic symptoms of pituitary tumors include weight gain, easy bruising, changes in bone structure, menstrual irregularities, lactation, and heat intolerance. Blurred vision, headaches, and peripheral field abnormalities are also common.
Pituitary headaches are often “vascular” in nature, much like migraines. Headache pain is characterized by a steady forehead pain. Due to the location of the pituitary gland, growth of the tumor may cause compression on the optic tracts and optic nerve causing blurred vision. Patients will have their peripheral visual fields monitored by an eye doctor to ensure the tumor is not growing.
8. Optic neuritis
Optic neuritis is an inflammatory demyelinating disorder of the optic nerve, which can indicate a diagnosis of multiple sclerosis. Myelination is insulation of the nerves which enables the nerve impulses to travel from the brain to the rest of the body. In conditions like optic neuritis and multiple sclerosis, inflammation has damaged the myelin sheath resulting in muscle weakness, stiffness, and muscle spasms as well as vision loss. Vision can be slightly reduced to a complete, but temporary loss in vision.
The pain with optic neuritis can be felt around the eyes or behind the eyes like a headache, but usually worsens on eye movements. Optic neuritis can cause pallor or whitening of the optic nerve and is diagnosed by MRI. Vision will improve over time with high-dose systemic steroids.
While most headaches with vision symptoms are benign in nature and can be treated with a simple eyeglass prescription, headaches can also be a symptom of a life-threatening systemic condition. If you have a headache that does not resolve in a few weeks, be sure to get evaluated by an eye doctor.
