What are the potential causes and treatments for symptoms including head pressure, dry eyes, and abdominal discomfort?

Symptom Evaluation and Management

Your symptoms of head pressure, dry eyes, and abdominal discomfort require targeted evaluation for dry eye disease as the primary concern, with consideration of less common causes of head pressure if symptoms persist despite appropriate dry eye management.

Dry Eye Disease Management

Initial Assessment and Treatment

The dry eyes should be addressed first as this is the most clearly defined condition among your symptoms 1:

• Start with preservative-free artificial tears if you need them more than 4 times daily 1
• Address environmental factors immediately: eliminate cigarette smoke exposure, humidify ambient air, avoid air drafts, lower computer screens below eye level, take regular breaks, and consciously blink fully 1
• Review all medications for potential exacerbating factors, particularly antihistamines and diuretics 1

Escalation for Persistent Symptoms

If symptoms persist beyond conservative measures 1:

• FDA-approved prescription options include topical cyclosporine 0.05% or 0.09%, lifitegrast 0.5%, loteprednol 0.25%, varenicline nasal spray, or perflurohexyloctane ophthalmic solution 1
• No single agent has proven superior to others in head-to-head trials, so selection depends on individual tolerance and response 1
• Treat contributing ocular conditions such as blepharitis or meibomian gland dysfunction concurrently 1

Important Caveat

Dry eyes and mouth together may indicate Sjögren's syndrome in approximately 10% of patients with aqueous tear deficiency 1. If you have both symptoms, testing for anti-Sjögren syndrome A antibody (SSA/anti-Ro), anti-Sjögren syndrome B antibody (SSB/anti-La), rheumatoid factor, and antinuclear antibody should be ordered 1.

Head Pressure Evaluation

Primary Considerations

The head pressure requires differentiation between several potential causes:

If the head pressure is orthostatic (worse when upright, better lying down):

• Consider spontaneous intracranial hypotension from CSF leak 2, 3
• This typically presents with nausea, neck pain/stiffness, and may have interscapular pain 2
• Opening CSF pressure would be below 60 mm H₂O, though may be normal with intermittent leaks 2
• Brain MRI with gadolinium typically shows diffuse pachymeningeal enhancement and brain "sagging" 2

If the head pressure is sharp, stabbing, and brief:

• Consider idiopathic stabbing headache treated with indomethacin as first-line 4
• Alternative NSAIDs like ibuprofen or naproxen may be used when indomethacin is contraindicated 4
• Avoid opioids entirely due to dependency risk and medication overuse headache 4

Critical warning about NSAIDs and your abdominal symptoms:

• Ibuprofen commonly causes gastrointestinal complaints including abdominal pain, nausea, and discomfort 5
• The syndrome of abdominal pain with NSAIDs can occur with fever, chills, nausea and vomiting 5
• If considering NSAIDs for head pressure, gastric protection may be needed 4

Abdominal Discomfort Assessment

Medication-Related Causes

Review for NSAID use as this is a frequent cause of abdominal discomfort, occurring in 4-16% of patients 5:

• Symptoms include stomach pain, nausea, vomiting, indigestion, bloating and flatulence 5
• If currently taking NSAIDs, consider discontinuation or gastric protection 4, 5

Rare but Important Consideration

If abdominal discomfort is associated with orthostatic headache and food intolerance:

• Consider Nutcracker syndrome (aortomesenteric compression) particularly if you have hypermobility, hematuria, or progressive gastric symptoms 6
• This is rare but can present with new daily persistent headache refractory to multiple treatments combined with worsening abdominal pain 6

Recommended Action Plan

1. Immediately implement dry eye management with preservative-free artificial tears and environmental modifications 1

2. Stop any NSAIDs if currently taking them, given your abdominal discomfort 5

3. Seek ophthalmologic evaluation for comprehensive dry eye assessment and consideration of prescription therapies if symptoms persist 1

4. Document head pressure characteristics: timing, position-dependence, duration, and associated symptoms to guide further evaluation 4, 2

5. If dry eyes and dry mouth coexist, request autoimmune serologic testing for Sjögren's syndrome 1

6. If head pressure is orthostatic with neck/back pain, pursue neuroimaging with brain MRI with gadolinium to evaluate for intracranial hypotension 2

7. If abdominal symptoms worsen or persist with food intolerance, gastroenterology evaluation is warranted to exclude structural causes 6