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Headaches and Traumatic Brain Injury


Headaches are the single most common symptom after a significant head injury. Headaches occur in 30-50% of patients after concussion. Many symptoms disappear after a few days, but a surprising number of victims suffer for months and years after an accident.

So what does an eye doctor have to say about headaches?

Headaches can significantly interfere with visual function. For example, headaches can limit computer use. Computer screens test the limits of normal individuals- it is clear that prolonged viewing causes eye strain and headaches. But after severe whiplash or head trauma, headaches can become disabling.

The reality of most people’s world is that it is hugely dependent on a computer screen. If an individual experiences painful headaches, work cannot get done, income is lost.

Patients with headaches often experience eye pain. And eye pain must be investigated by an ophthalmologist to make sure there is no internal eye disease. The eyes and brain are so close together that patients often have a hard time distinguishing between headaches and eye pain. Often trauma involves direct impact with the bones around the eye, and can cause orbital fractures (the orbit is the tissue and structures surrounding the eye). The orbit tends to cushion a blow to the eye and protect the eyeball.

Injury to these structures can cause pain and need to be reviewed by an ophthalmologist with experience in dealing with orbital trauma. A CT scan or MRI scan of the orbits may be necessary to evaluate eye pain after trauma. Broken bones around the eye can often be hidden but clinically important.

Patients with head trauma are frequently referred to neurologists, chiropractors, and pain management specialists for treatment and evaluation of headaches. Why are ophthalmologists left off the list of needed specialists? The truth is that most eye doctors are simply not interested and do not know how to take care of these head injury victims. My effort in writing these blogs is an effort to get my colleagues more involved, it’s not all cataracts and LASIK.

I specialize in the care of Traumatic Brain Injury (TBI) patients and TBI patients with headaches and eye pain. Other specialists clearly have their role in this management, but pain is a very real symptom after trauma and can be the most disabling.

Do these patients need special computer glasses to help manage the pain and strain of long hours of concentration?

I attempt to establish the new visual needs of a patient with chronic headaches- eye doctors are uniquely trained to manage these difficult cases. Most of these patients don’t have direct eye injuries, but a patient experiencing eye pain doesn’t know this- that victim can think he/she is going blind. A thorough eye exam can separate fact from fiction. Patients can be told they are not losing vision, they are not damaging their eyes if they continue to work through the pain. No other medical specialty can offer this reassurance. I believe a thorough eye exam should be part of the complete evaluation of any patient experiencing headaches or eye pain after head trauma.

Treatment of headaches can be difficult and frustrating, but other specialists deal with these patients on a daily basis. I believe eye doctors can do better.

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