What’s Behind That Headache Behind Your Eyes?

What causes migraines?

Dubbed “the Mother of All Headaches,” migraines, which often manifests as extreme pain behind the eyes, affects one in 10 older adults. The three most common symptoms are: pain that interferes with your life, light sensitivity and nausea, says Kathleen Digre, M.D., professor of neurology and ophthalmology at the University of Utah’s John A. Moran Eye Center and a past president of the American Headache Society. “If you’ve got two of these three symptoms,” she says, “you’ve got a 90 percent chance of it being a migraine.”

Migraine attacks are often triggered by changes: in weather, sleep patterns, eating habits, even hormonal changes during menopause can trigger migraines in women. Attacks can also be caused by sensory stimuli, such as bright light, loud noises and strong smells. “All of the senses are ramped up in a person with migraines,” Digre says. “These are people who can smell somebody's perfume from three pews away in church, and that can trigger a headache.” Keeping a migraine diary — noting when they start and what they feel like — can help you figure out what is setting off symptoms.

How to relieve or prevent migraines

• Try medication. OTC pain relievers may help with mild discomfort, but most sufferers require prescription meds. Triptans, which should be taken at the first sign of an attack coming on, help block pain pathways to the brain. Lasmiditan, another option, improves pain as well as nausea and sensitivity to light and sound. (It’s similar to Triptan but safer for people with underlying cardiovascular diseases.) Your doc might also recommend calcitonin gene-related peptide (CGRP) monoclonal antibodies. They target and inactivate CGRP, a protein released by the nerves and blood vessels in the brain and known for carrying pain signals . They are administered as injectables. Gepants also target CGRP, but they are oral pills or dissolvable tablets designed for acute care and should be taken at the onset of an attack. The Food and Drug Administration recently approved a nasal spray, Zavegepant, that can bring relief within 30 minutes .

• Switch to brain-friendly lenses. About 80 percent of people who experience migraines also struggle with a heightened sensitivity to light. Some types of glasses can help soothe this symptom. “FL41 tinted lenses can block a certain wavelength of light that makes migraines worse,” Digre explains. Green light may also be beneficial.

• Try neuromodulation. The FDA has approved several wearable devices that stimulate nerves and modify the way they transport information to and from the brain to help decrease migraines. People with pacemakers should not use them. Neuromodulation on its own might not be able to make the migraines go away, but it can help reduce the number of medications you take.

• Avoid your triggers. Monosodium glutamate, or MSG, can cause a flare-up. “Caffeine is a two-edged sword,” Digre says. “Sometimes it can help, but if you take too much of it, it can actually give you a headache.” Other potential culprits: alcohol (especially fermented products, such as red wine, champagne or beer), aged cheeses, processed meats, chocolate and some artificial sweeteners (like aspartame). Your migraine diary can help you flag your personal triggers.

• Consider your magnesium intake. One study found that regularly getting magnesium into your system can reduce the frequency of migraine attacks by more than 40 percent. Have your doctor check your magnesium level to determine if you’re deficient. If you are, the American Headache Society suggests taking a 400–500 milligram supplement of magnesium oxide daily to prevent pain. But always ask your primary care doctor before starting any supplements, Digre says.

• Take time to relax. “Migraine sufferers need downtime, instead of being stimulated all the time,” Digre says. At the first sign of a slammer, take a break from your usual activities (if possible) and relax in a dark, quiet room. Apply a cold compress to your head, to dull the pain. There are even caps that you can buy (one called Icekap). “You slip hot or cold blue packs into the cap before putting it on,” she explains. “That works for some people, though it doesn’t always stop the nausea that comes with the migraine.”

• Exercise regularly. Exercise is a natural stress stopper that cues the body to release pain-killing endorphins. Bonus: These chemicals alleviate anxiety and depression, which can exacerbate migraines. Be sure you’re using good form (no slouching!), and don’t overexert yourself — both can trigger migraines. Healthy habits like this and eating right are key, Digre says. “I tell migraine sufferers, ‘You’ve got the Ferrari of brains. It’s sensitive and high-maintenance, and you’ve got to take care of it by living a balanced life.’ ”

What causes tension headaches?

The most common type of headache, a tension one, produces a dull, aching pain that can feel like a band wrapped tightly around your forehead, causing tenderness in the scalp, neck and shoulder muscles, and an ache behind the eyes. Some people experience tension headaches once or twice a month; others, more often. Stress, anxiety and fatigue are common culprits, and some of the lifestyle recommendations you’ve heard about migraines, like getting enough sleep or exercising regularly, can also help keep tension headaches at bay. Here are a few other strategies.

How to relieve or prevent tension headaches

• Try medication. Tension headaches can usually be treated with simple OTC pain relievers. Take an aspirin, ibuprofen, naproxen or acetaminophen at the first sign of tightness. However, don’t use OTC medications more than twice a week as you could trigger a rebound headache. If the pain is severe or you need medications more than twice a week, prescription meds may be necessary.

• Relieve the tension with massage. Have someone gently knead your head, neck and shoulder muscles. Or do it yourself with a targeted mini-massage, gently rubbing the painful spot on your head with your fingertips for a minute or two. You can also apply a heating pad set on low to your head for five to 10 minutes, as needed, or take a hot bath or shower, to relax tense muscles. Applying ice or a cool towel to your head can also help.

• Try relaxation. Keeping stress under control can help you manage your symptoms. If you feel overwhelmed, unwind with some slow stretches or deep breathing, or take a 15-minute walk around the neighborhood. A weekly yoga class can also help.

• Correct your posture. Poor posture can affect muscles in your neck and shoulders and could trigger tension-type headaches. Jaw clenching and teeth grinding could also be responsible for chronic tension-type headaches. Your dentist can check for signs of such conditions.

What causes sinusitis?

Anything that causes a buildup of pressure in your sinuses, such as congestion from a cold or allergy, can bring a painful pounding around the eyes as well as other parts of the face. Sinusitis is a sinus infection, with symptoms that can include postnasal drip and fever. It typically lasts two to four weeks. Sinusitis that lingers beyond 12 weeks, despite medical treatment, is considered chronic sinusitis. But if facial pain is the predominant symptom, you probably have a migraine disorder, not sinusitis, says Bradley Otto, M.D., an otolaryngologist at the Ohio State University Wexner Medical Center, in Columbus.

How to relieve or prevent sinusitis

Most people don’t need to see a doctor, as sinusitis usually goes away on its own and doesn’t require treatment beyond taking a short course of OTC painkillers or nasal sprays; hydrating well; applying warm face packs to ease decongestion; and resting. But if the infection lingers beyond 14 days, you might have a bacterial sinusitis and should see a doctor.

Other ways to thwart pain and pressure:

• Steam your sinuses. Steam adds moisture to the air, helping to moisten your sinus passages and thin out thickened mucus. Take a hot shower and breathe in the steam, to reduce pressure. Place warm, damp towels around your nose, cheeks and eyes, to ease facial pain. For long-term relief, use a humidifier.

• Try nasal sprays. To help keep nasal passages open and reduce sinus pressure, use a nasal saline spray or steroid spray (like Flonase), which can loosen thick, dry mucus. You can also try a neti pot (a teakettle-like device used to irrigate the sinuses with a warm saline solution). “Just make sure you're using distilled, not tap, water,” Otto warns, and don’t flush more than once a day.

• Exercise. Staying active — particularly engaging in aerobic activities, such as walking, swimming and biking — can also relieve sinus pressure.