Introduction
Headaches are one of the most common clinical pictures in everyday practice. Chronic headaches also occur frequently in the population. The pain can be present in very different regions of the head. The pain often drags behind one or both eyes, sometimes it is less dragging than localized.
Pain as a leading symptom
Pain behind the eye can have various causes. Often it is a tension headache or an incorrectly adjusted diopter of the glasses. However, in rare cases tumors can also cause pain.
Depending on how the pain is characterized (stabbing, pressing, etc.) and where exactly it occurs, different clinical pictures can be narrowed down. Pain behind the eye, which appears knocking, is usually caused by the very frequent migraine.
The exact cause why this knocking painful phenomenon occurs is still not completely understood. It is often the case that accompanying symptoms such as nausea or sensitivity to light also accompany the pain behind the eye. A migraine attack can occur suddenly or a few hours before through the so-called aura.
The aura is a term used to describe neurological phenomena such as impaired vision or an indescribable, uncomfortable feeling. The visual disturbances are characterized by rapidly rotating flashes that can severely restrict the field of vision. As soon as the visual disturbances have disappeared, the headache localized behind the eye begins.
A typical symptom of a migraine headache behind the eye is also often a pulse-synchronous character. The very strong pain does not allow the patient to move quickly, because the knocking pain behind the eye increases with the pulse rate. Only rarely does a migraine attack result in a pressing stationary pain behind the eye.
Sometimes a strong tension headache, which is actually located in the forehead area, can also pull behind one or both eyes. If pain behind the eyes occurs suddenly and has not disappeared after a few days, a tumorous event should be ruled out in any case. Tumors can form behind the eye and thus lead to increased pressure on the eyeball with its nerves, which can lead to stationary pain.
The examination is done by imaging with the help of a CT (computed tomography) or MRT (magnetic resonance imaging). Stabbing or pressing pain, which occurs when the eye is moved by focusing (focusing), is very common and has no disease value. Mostly in connection with a flu-like infection, pain behind the eye when moving the eyes is indicated.
A more detailed examination should only be carried out if the symptoms do not disappear after a few days. For “maximum diagnostics” an MRT or CT would be used. The treatment of such eye pain can be carried out with the conventional painkillers and anti-inflammatory drugs, such as ibuprofen or diclofenac.
Pain that occurs suddenly or insidiously behind both eyes at the same time can also always be related to changing visual acuity. If the eyes get worse and the required dioptre number of the glasses increases, the eye has to work harder to produce the focused image just as sharply. An eye test should definitely be carried out in this case, because the pain problem behind the eye is often already solved with the amplification of the necessary lenses.
If headaches behind the eye are mainly caused by movement of the head, it is probably a muscular cause. Either it is the eye muscles that are strongly strained during the rotational movement (especially if the eye only fixes one point when the head is rotating), or it is a muscular tension of the neck or face muscles that transmits the pain stimulus behind the eye. If pain behind the eye only occurs when the head is moved and no pain is triggered when the head is at rest, a tumor behind the eye is rather unlikely as a cause.
Although a tumor can be attached to an eye muscle in such a way that it only triggers painful pressure when the eye is moved, in this case imaging by MRI or CT should not be performed immediately, but only when the pain does not improve or even worsens after a few days.Pain behind the eye, which occurs in connection with pain in the forehead, is harmless in most cases and should only be clarified more precisely if the pain has not improved after a few days. In most cases, it is a tension headache, which is caused by stress or too little drinking, for example, and which starts from the forehead and is directed by nerves behind the eyes. As treatment, anti-inflammatory pain therapy should be started and the water balance should be checked.
Sometimes the reason for pain behind the eye and forehead can be due to a vascular cause. In a so-called sinus vein thrombosis, a blood clot is formed in one or more of the blood vessels supplying the brain. The formation usually goes unnoticed and only becomes symptomatic when there is a pulling pain from the forehead into the eyes.
The first indications of sinus vein thrombosis are provided by the blood count with increased D-dimers. An MRI angiography then often already shows the blood clot in the area of the sinus (blood vessel of the brain). The combination of pain behind the eye and in the neck, are very common and often due to tension.
The neck muscles, which are located in the area of the upper spine sections, are very strong and also sensitive. Mental tension often leads to tension of the neck muscles. This is then locally at the neck very pressure painful and can also radiate into other regions.
In addition to radiating into the forehead, arms and chest, the pain can also extend behind one or both eyes. As a rule, however, the pain cannot be triggered by eye movements. Although the affected persons complain of pain behind the eye, they can usually locate the starting point of the pain in the neck area.
Sometimes the neck and combined eye pain can also be accompanied by vision problems. In addition to anti-inflammatory and pain-relieving medication, heat treatment with a hot-water bottle placed in the neck can sometimes help. If this does not help and neck and eye pain occur repeatedly, you should also consider having an X-ray of the cervical spine.
Wear and tear of the vertebral bodies, which have developed over years, can be seen and displayed in this way. It must be said, however, that treatment in case of wear-related vertebral body changes is rather impossible. The most successful treatment of such complaints can most likely be carried out by training the muscles that stretch laterally along the vertebral bodies.
This is made possible by physiotherapy, which the family doctor or orthopedic surgeon can prescribe for those affected. As a rule, an appropriate training of the musculature next to the vertebrae of the cervical spine is carried out 2-3 times over a period of 3 weeks, which is conditioned by ligaments and weights and which relieves the cervical spine accordingly. Treatment with analgesic injections can also be performed.
In the procedure also known as wheals, an analgesic is injected directly under the skin above the lateral muscles of the cervical spine. The effect takes place relatively quickly. Unfortunately, however, the medication is also quickly flooded away from the body, which then leads to a renewed increase in pain.
In many family doctor’s practices, treatment with stimulation current is also offered. In this form of treatment, a current is sent through the muscles on the side of the cervical spine. The application lasts only a few minutes and should be perceived by the patient as a pleasant tingling sensation.
The most effective application is over approximately one week. Stimulation current treatments are usually also covered by the statutory health insurance. Every patient who reports pain in the neck and eyes should also be examined for meningismus (inflammation of the meninges).
With a simple test (strong bowing of the head to the chest), it can be found out whether meningitis may be the cause. In the case of meningitis, the patient would not be able to place the head on the chest. The most feared cause of pain behind the eye is the eye tumor.
Compared to other cancers, a tumor behind the eye occurs relatively rarely. It can be of benign or malignant origin. In addition to pain, which it can usually cause behind the eye at rest and in movement, it causes discomfort mainly due to the increasing pressure it causes on the eye.
The tumor on the eye can ultimately occur in any position.It often occurs behind the eye or even behind the retina. A special feature of the treatment is, besides the malignancy, also the location. This is because some tumors, even if they are of benign origin, are very difficult to access surgically.
In this case, an attempt is made to reduce the size of the tumor by irradiation before it is approached surgically. Some tumors are located so unfavorably that surgical intervention would endanger the optic nerve and thus the visual light. Benign tumors can be left as they are and hoped that they will not grow larger.
A growing tumor must be surgically removed sooner or later, even at the risk of damaging the eye. In some cases, the only option left is a complete surgical removal of the eye. In addition to the pain behind the eye that is sometimes triggered, the patient often perceives visual disturbances as the first symptom.
Some eye tumors can also be seen by the ophthalmologist directly through an ophthalmoscopy. The most common eye tumors are retinoblastoma in children (18,000-20,000 newborns and about 60 children per year), and choroidal melanoma in adults (malignant tumor resulting from certain cells in the choroid in the eye). In most cases, the affected patients also report visual disorders.
Some tumors develop so large that they exert pressure on one or more eye muscles. This has the consequence that the affected eye can no longer be moved in the usual way. This leads to a deviation of the eye axis and to strabismus or outward vision.
If an eye tumor is suspected, an imaging of the head should definitely be performed. This is where the MRI examination comes into play. It takes about 15-20 minutes, is usually performed with a contrast medium and makes possible tumors in the area of the eye visible.
