Characteristics of patients presenting with ocular pain

Background: The purpose of this study was to assess the utility of neuroimaging in patients with normal neuro-ophthalmic examinations referred to a neuro-ophthalmology clinic for complaints of chronic isolated eye pain. We were also interested in the prevalence of primary headache syndromes in these patients, particularly medication overuse headache (MOH). Methods: Charts of 125 consecutive patients referred to a neuro-ophthalmology clinic with some form of head or facial pain were reviewed to find patients meeting the criteria of having complaints of chronic eye with normal neuro-ophthalmic examinations. Excluded were patients with primary complaint other than eye pain. A single examiner performed all examinations in a standardized fashion. Each patient was queried about the use of prescription and over-the-counter analgesics. Results: Seventy-three percent of patients had some form of primary headache syndrome, and 21% of patients had some component of probable MOH. Another 4.5% had a presumed component of medication overuse. None of those who received imaging had any results explaining the ocular pain. Interpretation: Primary headache is present in most patients with chronic, isolated ocular pain. MOH is common and probably underrecognized in this population. It needs to be addressed if the patient is ever to be pain free. Neuroimaging has very low yield in this group of subspecialty referral patients.