What causes unilateral eye migraine (headache)?

From the Guidelines

Migraines behind one eye should be managed with a combination of preventive pharmacologic treatments and lifestyle modifications to reduce frequency and severity, as recommended by the American College of Physicians in their 2025 clinical guideline 1. When experiencing a migraine behind one eye, it is essential to prioritize reducing the frequency and severity of the migraine to improve quality of life.

Key Considerations

• The main goal of prevention is to reduce the frequency and severity of migraine headache, and considerations for preventive pharmacologic treatments include frequency, severity, duration, and functional disability 1.
• Many pharmacologic treatments are available, including beta-blockers (propranolol 40-160mg daily), anticonvulsants (topiramate 25-100mg daily), and CGRP antagonists, which have been granted U.S. Food and Drug Administration (FDA) approval for migraine prevention 1.
• For immediate relief, over-the-counter pain relievers like ibuprofen (400-600mg) or acetaminophen (1000mg) can be effective, and rest in a dark, quiet room may also help reduce pain and inflammation.

Diagnosis and Management

• Suspect migraine without aura in a person with recurrent moderate to severe headache, particularly if pain is unilateral and/or pulsating, and when the person has accompanying symptoms such as photophobia, phonophobia, nausea and/or vomiting 1.
• A family history of migraine and onset of symptoms at or around puberty can strengthen the suspicion of migraine 1.
• If migraines occur more than four times monthly, preventive medications may be necessary, and prescription medications such as triptans (like sumatriptan 50-100mg) can be effective when taken at the first sign of a migraine.

Important Notes

• Migraines can be underdiagnosed and undertreated, with only a small percentage of eligible people receiving preventive pharmacologic treatments 1.
• Triggers commonly include stress, certain foods, hormonal changes, and lack of sleep, and avoiding these triggers can help reduce the frequency and severity of migraines.
• If a migraine includes visual disturbances, severe pain, or is accompanied by neurological symptoms like weakness or speech difficulties, seek immediate medical attention to rule out more serious conditions.

From the Research

Migraine Behind Unilateral Eye

• Migraine is a common disease that can cause severe headache, often unilateral, and can be accompanied by other symptoms such as photophobia and phonophobia 2, 3.
• The treatment of migraine can include prophylactic medications, such as beta-blockers, flunarizine, topiramate, valproate, and amitriptyline, which are considered first-line treatments 4.
• Anti-epileptic drugs, such as topiramate and valproate, are also effective for migraine prophylaxis and can be used to prevent frequent migraine attacks 5.
• For acute migraine treatment, medications such as sumatriptan and metoclopramide can be used, and intravenous valproic acid has been shown to be effective in relieving headache and other associated symptoms 3.
• A study comparing intravenous valproic acid with intramuscular metoclopramide + subcutaneous sumatriptan found that valproic acid was more effective in relieving headache during the first 2 hours 3.
• Metoclopramide has also been shown to have pain-relieving effects for migraine and can be considered as a first-line medication for migraine attacks in emergency department settings 2.