Optometrists’ role in diagnosing and managing headache-related conditions highlighted at SECO 2025

A session by Anthony DeWilde, OD, FAAO, at SECO 2025 provided key insights into diagnosing and managing headaches in an eye clinic setting. The session outlined strategies for differentiating vision-threatening headaches from non-vision-threatening cases, emphasizing the importance of thorough evaluation.

Vision-Threatening Headaches
Dr. DeWilde highlighted several conditions requiring urgent attention, including:

• Giant Cell Arteritis (GCA): Most common in patients over 50, GCA presents with symptoms such as jaw claudication, scalp tenderness, fatigue, and weight loss. Diagnostic workups should include CBC, CRP, and ESR tests.
• Intracranial Hypertension: Often associated with severe headaches that worsen with posture changes, it may present with tinnitus and can progress to a vision-threatening state.
• Intracranial Tumors: Pituitary tumors and other intracranial masses may initially manifest as headaches. Optometrists play a key role in early detection through OCT and visual field testing.
• Ocular Conditions: Elevated intraocular pressure, uveitis, and cellulitis can also contribute to headache symptoms and require comprehensive examination.

Non-Vision-Threatening Headaches
Many headaches encountered in eye clinics stem from refractive errors, binocular vision dysfunction, and common headache syndromes such as tension headaches, migraines, and cluster headaches. Key considerations include:

• Refractive Causes: Miscoordination of refractive correction, including presbyopia, can lead to eyestrain-related headaches.
• Binocular Vision Issues: Phoria, vergence, and accommodative dysfunction should be assessed.
• Headache Syndromes:
  • Migraines may include aura, photophobia, and a characteristic prodrome-headache-postdrome sequence.
  • Cluster Headaches present with pain behind one eye, sometimes accompanied by Horner’s syndrome symptoms such as lid drooping and epiphora.
  • Trigeminal Neuralgia can cause severe facial pain, including post-herpetic neuralgia.

Visual Aura Without Headache
Dr. DeWilde emphasized the importance of recognizing scintillating scotomas, which can alarm patients who may suspect stroke or brain tumors. Proper reassurance and differential diagnosis are essential.

Reference
DeWilde A, et al. Optometrist’s Guide to Headaches. Presented at: SECO 2025; February 26–March 2, 2025; Atlanta, GA.