Optometrists: Your eyes are fine, what now….
Optometrists are front line campaigners in the management of headaches and have a unique skill set that allows them to accurately diagnose whether the visual field is compromised, leading to headaches. They can then provide the necessary visual aids to rectify the problems. It is known to GP's and the general public that we need to eliminate vision as a primary cause of headaches, but what do we do when the optometrist clears the eyes as a factor. Or what do we do when we fix the patient's vision but the headaches don’t clear?
Thinking practically, we ask what is it about staring at computer screens that causes headaches. If you can clear the patient's eyes as a cause of pain, consider the position they are putting their shoulders, neck and head in to maintain their “computer posture”. There are some consistent characteristics of cervicogenic headaches that should be able to give you a clue that it is involved, and when you consider their posture, it becomes clear that the next step to determine the cause of their headaches is a cervical spine examination.
Thinking laterally, we need to consider the afferent inputs in the regions that the patient experiences headache pain. The Trigeminal Nerve (CNV) has three clear divisions, the Opthalmic branch runs along the temple and the brow and has divisions into the back of the eye socket and sinuses, the Maxillary branch innervates the soft palate, muscles of mastication and influences eustachian tube and even the stapes in the ear, and the Mandibular branch is responsible for the jaw and lower teeth. The processing centre for any information that is carried on any of the divisions of the Trigeminal nerve is actually located in the brainstem where there is convergence of nerve fibres from the C0, C1 and C2 Spinal nerves. In a nutshell, an irritation of the cervical spine can lead to referred pain along the Trigeminal nerve pathway and express pain in the temple, brow and eye socket, a grouping of symptoms that is commonly thought of as a result of eye strain.
Cervical Spine assessment to determine or eliminate musculoskeletal origin of headaches is becoming more relevant and the more pathways we have through more health professionals to get the neck assessed, the better chance we have of changing the lives of our patient's.
Author: Nigel Smith