Neurology: Headaches in optometric practice part 2 – trigeminal neuralgia

A 46-year-old patient had been suffering intermittent severe headaches for six years and was under the care of her general practitioner. The headaches would occur at least weekly and could last between a few hours up to several days.

There was no visual aura, although her practitioner had been treating her for migraines (in error as it turned out). Her GP suggested that she had an eye test before he would consider treating her for cluster headaches.

On her first visit to the practice, careful questioning of the nature of the headaches revealed that she had been suffering a very sharp boring pain behind the right eye and, on many occasions, pain from the right lower teeth. She had tried a host of pain killers (Imigran, paracetamol and ibuprofen) to no avail. There was no general health or refractive issues and no family history of migraines.