• Neuro-Ophthalmology/Orbit

    This paper describes ophthalmic symptoms of primary headache disorders that typically prompt patients to present for neuro-ophthalmic evaluation.

    Study design

    The authors identified published literature by searching PubMed for the following terms paired with “migraine” and “headache”: dry eye, eye pain, monocular diplopia, binocular diplopia, photophobia, visual field defect, tunnel vision, floaters, amaurosis fugax, transient visual obscuration, autonomic symptoms, anisocoria, visual snow, Alice in Wonderland syndrome and palinopsia.


    Patients with migraine experience a wide range of visual disturbances, including aura and complex perceptual abnormalities such as Alice in Wonderland syndrome and visual snow. Visual disturbances consist of positive and/or negative phenomena, and may be binocular or monocular. Migraine and other primary headache disorders are linked to photophobia, eye pain, dry eye, autonomic features and anisocoria. Trigeminal autonomic cephalgias are less common, and patients report both autonomic and ophthalmic complaints.


    Literature reviews are inherently limited by the design and scope of the original studies.

    Clinical significance

    Understanding the typical features associated with headache disorders will help providers steer patients toward appropriate treatment, prevent unnecessary testing and help identify atypical presentations that require additional evaluation.