My least favorite headache is one that is announced by some fifth grader who can’t do his homework because it gives him a headache. It’s often easy to explain that the headache is not serious—nothing more than a mild reaction to Social Studies. (YOU try writing a paper about the Magna Carta with no pain between your ears.) As a matter of fact, a study by our OMD colleagues determined that childhood headaches are almost never caused by the eyes. They left out the part about childhood headaches being caused by contact with OMDs. But, just when you think it’s safe to count “headache” as a worthy symptom, some doctor writes an article here in Review of Optometry about a patient who complained of frequent headaches, and it turned out to be some brain-boring millipede infestation! Try explaining why you thought it was just the patient’s sinuses, like it is for 99.9999999999999999999999% of other patients, while some brain-boring-millipede-infestation specialist sits there under oath explaining how this was so obvious that any numbskull should have diagnosed it properly just by what the patient told your receptionist about why he was 30 minutes late for his appointment.
The Chocolate Chip EtiologyMy own headaches are self-inflicted injuries caused by my attempts at suicide by cookies—my drug of choice when stress kicks in. Oh, I’ve learned to just walk right by the cookie jar most of the time when I’m freaking out about something optometric—like why they change the rules every day, or why people tell me there’s nothing more important than their vision when they show up once every 17 years, or why they don’t have enough money to update their glasses but they had a great two weeks at Disney World, or they have to cancel their appointment this afternoon because they have a pedicure scheduled, and on and on. Why would that cause a headache? Must be the cookies!
But even when I have a headache, I get in the car and get to the office. A couple ibuprofen and I’m at it. Interesting that if a staff member has a headache, they have to take the day off and go shopping with friends. The only reason scientists think migraine headaches can be related to bright sunlight is that my staff members happen to get migraines only when it’s beautiful and sunny and they have to take a “sick day.” Maybe migraines are also related to when the city pool is open.
Still, it’s important to pay close attention to any patient who presents with a headache. Make sure you carefully examine all aspects of their ocular health and visual system while evaluating appropriately for neuro-ophthalmic symptoms and/or signs, other medical concerns, and possible medication side effects. Then send their manic six-year-old out to grandma in the reception area and watch the patient’s headache disappear. Oh, and confiscate any cookies for “analysis.”