Differential Diagnosis for Unilateral Eye Pain with Headache
- Single most likely diagnosis
- Migraine: This is often characterized by unilateral headache and can be accompanied by eye pain, photophobia, and other visual disturbances. The unilateral nature of the pain and its association with headache makes migraine a leading consideration.
- Other Likely diagnoses
- Cluster headache: Known for severe, unilateral orbital or periorbital pain, often accompanied by headache and other autonomic symptoms like lacrimation and nasal congestion. The pain is typically on one side of the head and can be excruciating.
- Optic neuritis: Inflammation of the optic nerve can cause unilateral eye pain, especially with eye movement, and is often associated with visual disturbances. It's a common condition in young adults, particularly those with multiple sclerosis.
- Acute angle-closure glaucoma: This is an ophthalmic emergency characterized by sudden, severe unilateral eye pain, headache, blurred vision, and often accompanied by nausea and vomiting. It's caused by increased intraocular pressure.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Giant cell arteritis: Although less common, this condition can cause unilateral headache and eye pain, particularly in older adults. If left untreated, it can lead to blindness, making prompt diagnosis and treatment critical.
- Cavernous sinus thrombosis: A rare but potentially life-threatening condition that can cause unilateral eye pain and headache, along with other symptoms like proptosis and cranial nerve palsies. It requires immediate medical attention.
- Pituitary apoplexy: A medical emergency where a pituitary tumor suddenly hemorrhages or infarcts, leading to severe headache, often unilateral, and can cause visual disturbances and eye pain due to its location near optic nerves.
- Rare diagnoses
- Tolosa-Hunt syndrome: A rare condition characterized by unilateral headache and eye pain due to nonspecific inflammation of the cavernous sinus or superior orbital fissure. It's diagnosed by exclusion and response to corticosteroids.
- Raeder syndrome: A rare condition that presents with unilateral facial pain, often including the eye, along with ptosis and miosis, due to sympathetic nervous system disruption, usually from a lesion in the middle cranial fossa.
- Ophthalmic herpes zoster: While not rare in the general population, it's less likely to be considered initially for unilateral eye pain with headache. However, it can cause significant pain and potentially lead to complications like uveitis or glaucoma if not treated.