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What's Behind That Headache Behind Your Eyes?

How to find relief from the pain and discomfort caused by migraines, eye strain, tension and sinus issues

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Jeremy Woodhouse/Getty Images

En español | Blurry vision, dryness, itchiness — all are common eye complaints that may suggest an underlying problem. But perhaps the most uncomfortable, not to mention worrisome, symptom is pain that occurs behind the eyes. It can be a sign of a range of issues, including eye strain, migraine and sinus infections. Depending on the cause, there are ways to eradicate the ache and get some sweet relief.

Some common reasons for behind-the-eye aches:

Eye strain

Our muscles aren't the only part of our body that can become fatigued and sore after overuse. Eye strain can lead to eye pain. Reading without giving eyes a rest, driving long distances, being exposed to glare (or straining to see in poor lighting) or coping with an underlying eye problem (say, uncorrected vision) can cause trouble. And then there are those digital devices. “When you look at anything intently, over a long period of time, you override your natural tendency to blink, which keeps eyes moist,” says Andrew Iwach, M.D., an associate clinical professor of ophthalmology at the University of California, San Francisco, and spokesperson for the American Academy of Ophthalmology. “That can lead to dry eye or exacerbate an underlying dry eye condition, creating pain and discomfort.”

Treatment

"Give your eyes a rest, get a good night's sleep, and things usually get better on their own,” Iwach says. Here are a few other ways to get relief.

  • Keep eyes lubricated. Over-the-counter artificial tears can lubricate the ocular surface to prevent or relieve dry eyes. “Don't wait until you have symptoms to use them,” Iwach cautions. “If you tend to experience dry eye symptoms at 2 or 3 in the afternoon, start using artificial tears earlier in the day. You'll be able to work longer and end up using less in the long run."

  • Avoid digital eye strain. Glare can strain eyes, making it difficult to see objects on your monitor. Consider turning off some of the overhead lights or place an anti-glare cover over the screen. Also, keep the screen about an arm's length away. “Make sure the height of the monitor or laptop is at a comfortable height, just below eye level,” Iwach advises.

And during video calls, he adds, people tend to blink less in order to appear engaged: “Make it a habit to blink more often when looking at the monitor, and give eyes a break by looking away every now and then.” When you're by yourself, apply the 20-20-20 rule: For every 20 minutes you spend in front of a screen, look at something 20 feet away for at least 20 seconds.

Migraines

Dubbed “the Mother of All Headaches,” migraines affect 12 percent of Americans, and many — about 90 percent of sufferers — have a family history of migraines, which often manifest as extreme pain behind the eyes. The common symptoms are pain that interferes with your life, light sensitivity and nausea, says Kathleen Digre, M.D., a professor of neurology and ophthalmology at the University of Utah's John A. Moran Eye Center and immediate 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.”

When to See a Doctor

How do you know if a headache is a cause for concern? Watch out for these signs — commonly referred to with the acronym SNOOP, so they're easier to remember — that can suggest a more serious problem:

  • Systemic symptoms (such as a headache with a fever or weight loss)
  • Neurologic symptoms (mental confusion, impaired alertness or trouble speaking)
  • Onset (sudden, split-second headache pain)
  • Older (a new onset, particularly in those 50 and older)
  • Previous headache history (a different type of headache than you're accustomed to, such as a change in attack frequency or severity)

Changes are often catalysts for this type of headache: changes in weather, changes in sleep patterns, changes in eating habits, even the change of life (hormonal changes, during menopause, can trigger migraines in older 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 — can help you figure out what is setting off symptoms.

Treatment

  • Medication: OTC pain relievers may help with mild discomfort, but most sufferers require prescription meds. Triptans, which you should take when you feel an attack coming on, help block pain pathways to the brain. Lasmiditan, a new oral medication approved for the treatment of migraines, improves pain as well as nausea and sensitivity to light and sound. (It's similar to Triptan but safer for those with underlying cardiovascular diseases.) Another game changer: calcitonin gene-related peptide (CGRP) antibodies. They target and inactivate CGRP, a protein released by the nerves and blood vessels in the brain, known for causing migraines. “It's a once-a-month shot, instead of taking a pill every day,” Digre explains. “And now there's a new IV formulation, and that's given every three months.”

  • Understand your triggers. Monosodium glutamate (MSG), for one, 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 NutraSweet or aspartame).

  • Consider your magnesium intake. One study found that regularly getting magnesium into your system can reduce the frequency of migraine attacks by 41.6 percent. Have your doctor check your magnesium level to determine if you're deficient. If you are, the American Migraine Foundation suggests taking a 400–500 milligram supplement of magnesium oxide daily to prevent pain.

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  • 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.’ “

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. They come from stiffness in your neck, forehead and face, with overly taut muscles aggravating nerve endings. Stress, anxiety and fatigue are other common culprits.

Treatment

  • 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. If the pain is severe, prescription meds may be necessary.

  • 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.

  • 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. Now that gyms are starting to open, consider a weekly yoga class.

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.

Treatment

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.

Other ways to thwart pain and pressure:

  • Steam therapy: 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. Or, for long-term relief, use a humidifier.

  • Nasal spray: 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 activties, such as walking, swimming and biking — can relieve sinus pressure.

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