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Excerpt:
Understanding Glaucoma and HeadachesGlaucoma is usually a painless disease. In fact, primary open-angle glaucoma – the most common type – is often called the “silent thief of sight” (). Because eye pressure (intraocular pressure, or IOP) in open-angle glaucoma rises slowly over years, the eye’s pain sensors (in the trigeminal nerve) never get triggered. In practical terms, this means chronic glaucoma like open-angle glaucoma does not itself cause headaches (). If someone with open-angle glaucoma does wake up with a headache, the cause is almost certainly something else – perhaps stress, migraine, sinus issues or more – and it should be evaluated on its own merits, rather than blamed on the glaucoma. Proper treatment for both the eye and the headache can be delayed by assuming a connection that isn’t really there.That said, some forms of glaucoma do cause head pain. Below we contrast the painless “slow” glaucoma with the painful “fast” glaucomas and other scenarios where headaches really may be related to the eye. We will also discuss how to tell a serious glaucoma-related headache from an ordinary headache and what to do about it.When Glaucoma Doesn’t Cause Headache: Primary Open-Angle GlaucomaIn primary open-angle glaucoma (POAG), the eye’s drainage angle stays open but the fluid drains slowly, so pressure creeps up over time. Because the rise in pressure is gradual, the eye has time to adapt and pain sensors are not activated. Doctors and vision patients alike often describe open-angle glaucoma as asymptomatic until the late stages of vision loss (). In other words, most people with POAG will never feel an ache or headache from the disease itself. It is crucial to appreciate this. If you have been diagnosed with POAG (or ocular hypertension) and you experience headaches, those headaches are almost certainly unrelated. They deserve a separate work-up – perhaps by your primary care doctor or a neurologist – and attributing them casually to “glaucoma” can be misleading. Likewise, if a patient has chronic headaches and also happens to have glaucoma, don’t assume one caused the other without evidence. Open-angle glaucoma should not prevent headache evaluation, nor should headache evaluation delay glaucoma care, but both deserve attention. Key Point: Chronic, gradual IOP elevation in open-angle glaucoma does not trigger pain receptors. If an open-angle glaucoma patient has a headache, look for other causes (). Acute Angle-Closure Glaucoma: A Painful EmergencyBy stark contrast, acute angle-closure glaucoma (AACG) is an emergency that usually causes severe, unmistakable pain. In angle-closure glaucoma, the front part of the eye suddenly becomes blocked: the iris bows forward and closes off the drainage angle. Aqueous fluid cannot escape, and intraocular pressure jumps dramatically – often well above 40–60 mmHg (normal pressure is ~12–22). This rapid pressure spike presses on pain-sensitive structures and leads to a throbbing, often blinding headache or eye pain. The headache in AACG is typically severe and unilateral (on the side of the affected eye). It is often described as a deep ache around the eye, brow or temple (a frontal or periorbital headache). Patients might also see blurred vision, halos around lights, and feel nauseous or vomit as the IOP soars (). In clinics and textbooks, acute angle-closure
