In my continuing summary of some of the Migraine World Summit presentations (back in early 2024), today’s blog post is about the presentation by neuro-ophthalmologist Deboah Friedman from Dallas, USA. She listed a huge number of conditions in which pain can occur behind the eye.
The main take away was that if you experience sudden / unusual pain in the eye, go to an ophthalmologist for an eye check, and if the actual eye is cleared of problems, then seek a referral to a neurologist from your family doctor.
In terms of migraine symptoms, Dr Freidman said it was typical to get pain in the eye, as well as occasionally getting red eyes, dry eyes, a drooping eyelid, a teary-eye, sensitivity to light which can lead to squinty-eye, and sometimes changed pupil size or a runny nose.
Sore eyes also occur in the ‘cousin’ headaches as well, especially cluster headaches, and occasionally tension headaches. She also mentioned you can get sore eyes from dental procedures as a referred pain.
Very rarely, a sore eye can be the symptom of a more serious disease (she listed several, including all the scary sounding things like aneurysms, tumors, cancer and thyroid problems) – but she reiterated that if you’re a migraine-person, it’s much more likely that the sore eye is a symptom of migraine.
The quickest way to tell whether there is ‘another’ problem is to take your migraine medication. If the pain in your eye reduces as well as the pain in your head (neck, stomach etc) then it is much more likely the eye pain is related to migraine only.
There was a question about ‘ocular migraine’ which Dr Friedman shut down and noted that there is no such thing – the migraine is happening in the brain not the eye. That said, there is ‘migraine aura without headache’ where people experience visual disturbances without other migraine symptoms [for example, zig zags, flashing lights or black spots (which I’ve never experienced)]. But again, she reiterated, this is not a malfunction of the eye – the disturbance is occurring in the brain.
It was a fascinating presentation, but a lot was out of my depth, or not specifically related to migraines, which is why my summary is so short – definitely not a reflection on Dr Friedman’s presentation.
[As I’ve mentioned elsewhere on this blog, as part of my chronic migraine symptoms, I have had pain in my right eye for over two years now – non stop, 24/7. I’ve been to an ophthalmologist twice now as part of my annual eye test for my reading glasses. Both times I described the pain that I was feeling, and both times my ophthalmologist nodded and frowned, ran her tests and said; ‘there’s nothing wrong with your eye’. I’ve also had an MRI which found nothing ‘scary’ within the brain that would put pressure on the eye from the other side, as it were. Also, in accordance with the above information, when I do take my migraine medications, the pain in my eye eases – although it does not disappear entirely or for long, and remains a ‘low level nuisance’. It seems pretty certain that the eye itself is fine – and so is the brain – there’s just a right royal mix-up with the pain messaging!]
Take care taking care of your eyes, Linda x
[PS – Disclaimer – if you’re new to the website, please know that I’m not medically trained, so everything I write is my best endeavor to understand a complicated neurological condition – please speak to a professional health care provider for medical advice specific to your individual situation.]
PPS – the notion that ‘ocular migraine’ may or may not be a thing, made me curious to do a bit more research – the debate seems to be as much about nuances or definitions as much as anything else. For example, whether your eyes cause a migraine (because you need reading glasses for example), or the migraine causes the sore-eye (along with sore everything else), or the disturbances are in the eye-only (such as aura without headache). Here’s some more websites if you’re interested in exploring the subject further:
Ocular Migraine: What It Is, Causes, Symptoms & Treatment (clevelandclinic.org)
Ocular Migraines: Understanding & Treating Ocular Migraine | AMF (americanmigrainefoundation.org)
Ocular Migraine: Symptoms, Differences, Auras (healthline.com)
The Mindful Migraine 
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