Bill Harvey: A head rings out
Author: Bill Harvey
I have often felt that eye care practitioners play an essential role in the screening of patients with headaches. This is undoubtedly supported by many of our GP colleagues who regularly refer their headache patients to us for further assessment and confirmation of any ocular or optical element to the symptoms.
Having just completed a number of stage 1 assessment visits this year, I am always surprised by how many colleagues feel that assessment of a ‘patient presenting with an ocular symptom or sign suggestive of a neurological condition’ as required by the College of Optometrists, excludes headache presentations from this category.
Instead, all too often, a pre-reg will present a case of a longstanding rare condition (a classic example being an old visual pathway defect with field loss respecting the vertical midline). Though technically this meets the requirement, such a patient really only demonstrates the ability to press a button for an already established fields assessment as might easily be carried out by a well-trained clinical assistant.
A thorough questioning of the nature of a headache helps establish the type of headache (whether it be migrainous, cluster, asthenopic, postural or, albeit rarely, related to a more sinister origin) and triggers (changed viewing habits, for example) and a subsequent careful assessment of the refraction (especially incipient presbyopia and accommodation imbalance), correction (induced prism perhaps) and binocular status (decompensated phorias) may allow the ECP to help resolve the issue both through advice and optical management.
Fields (vertical respect), disc margin assessment and pupils all help rule out more sinister conditions. Surely this is a better test of the ECP screening for neurological concerns.
I mention this as, this week, NICE has offered its support for a new treatment for cluster headaches, the gammaCore. This device stimulates the vagus nerve through the skin and is found to help reduce the frequency and severity of cluster headaches. We all
need to keep up to date with headache managements.