11.3.3 Headache attributed to ocular inflammatory disorder

Description:

Headache caused by ocular inflammatory conditions such as iritis, uveitis, scleritis or conjunctivitis and associated with other symptoms and clinical signs of the disorder.

Diagnostic criteria:
  1. Periorbital headache and eye pain fulfilling criterion C
  2. Clinical, laboratory and/or imaging evidence of an ocular inflammatory disease known to be able to cause headache1
  3. Evidence of causation demonstrated by at least two of the following:
    1. headache has developed in temporal relation to the onset of the ocular disorder
    2. either or both of the following:
      • a) headache has significantly worsened in parallel with worsening of the ocular inflammatory disease
      • b) headache has significantly improved or resolved in parallel with improvement in or resolution of the ocular inflammatory disease
    3. either or both of the following:
      • a) headache significantly improves with topical application of local anaesthetic agent to the eye
      • b) headache is aggravated by pressure applied to the eye
    4. in the case of a unilateral ocular inflammatory disease, headache is localized and ipsilateral to it2
  4. Not better accounted for by another ICHD-3 diagnosis.
Notes:
  1. Ocular inflammatory diseases known to cause headache include iritis, uveitis, cyclitis, scleritis, choroiditis, conjunctivitis and corneal inflammation.
  2. Because of nociceptive field overlap and convergence (leading to complex pain referral), any ocular source of pain may lead to headache in any region. Nevertheless, when the ocular inflammatory disease is unilateral, headache is likely to be localized and ipsilateral.
Comment:

Ocular inflammation takes many forms, and may be categorized variously by anatomical site (eg, iritis, cyclitis, choroiditis), by course (ie, acute, subacute, chronic), by presumed cause (eg, endogenous or exogenous infectious agents, lens-related, traumatic) or by type of inflammation (granulomatous, non-granulomatous).