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Can Dry Eyes Cause Headaches?

Dry eye is a relatively common problem which can cause a range of symptoms, including headaches and migraines.

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Dry eye is a common problem which can cause a wide variety of symptoms. Headaches are a symptom which is often associated with vision issues. So where do dry eye and headaches intersect?

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Dry Eye, and Headaches

Headaches and dry eye are both conditions which can be caused by a variety of issues. In the case of dry eye it is usually due to reduced tear production or a problem with the quality of tears produced. In the case of headaches, while there are vast numbers of potential causes, anything which affects vision can lead to headaches, as we then have to work harder to see, which can lead to eye strain, which in turn can cause a headache.

Headaches, migraines in particular, are closely linked to dry eye. While it is not completely clear why dry eye and migraines are connected, one possibility is that both conditions can be caused by inflammation. However, there is still research to be done to determine whether dry eye causes headaches or if dry eyes are themselves a symptom of headaches. 

A 2015 study has found that the reason some people suffer from frequent migraines may be due to a structural difference in the eye. In the study, researchers found that migraine sufferers in fact have a different ocular structure, and the same study saw that symptoms of dry eye are more prevalent in people who suffer from migraines. (https://pubmed.ncbi.nlm.nih.gov/22710496/)

On the other hand, dry eye and headaches can also both be side effects caused by things like medication, and some medications, like isotretinoin (the active ingredient in a popular acne medication), can cause both conditions.

One Can Affect the Other

One Can Affect the Other

Regardless of whether one does in fact cause the other or not, suffering from both dry eye and headaches can make things extra unpleasant. Some research indicates that migraine attacks can be longer and more severe in people who are also suffering from dry eye.

At the same time, people with migraines are more likely to experience dry eye, and dry eye can lead to a migraine taking on different qualities. In addition to lasting longer, migraines in dry eye sufferers can also come with feelings of nausea and sensory sensitivity, and may cause vomiting.

A Deeper Look at Connections

A Deeper Look at Connections

In addition to inflammation, there are other theories regarding shared mechanisms which can cause both dry eye and headaches.

Trigeminal nerve pathway: The trigeminal nerve is the largest of the 12 cranial nerves, and it supplies nerves to the eyes in addition to playing a role in tear production. Some scientists believe that when this nerve system is activated, migraines can result. 

Dry eye, as well, is thought to be a result of an activated trigeminal nerve, since there are dense trigeminal nerve endings in the cornea. In fact an innovative new treatment for dry eye that is based on stimulating the trigeminal nerve was recently approved by the FDA. The FDA approved varenicline nasal spray 0.03 mg (Tyrvaya, Oyster Point Pharma) for the treatment of the signs and symptoms of dry eye disease (DED). According to Marian Macsai, MD, chief medical officer of Oyster Point Pharma “It is the first and only nasal spray approved for the treatment of the signs and symptoms of DED, and it is the first and only pharmacological approach to cholinergic neuro-activation via the trigeminal parasympathetic pathway.”

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A recent study has found that people with migraine and dry eye symptoms had much less corneal nerve fiber than others, which further indicates that there is some link between the trigeminal  nerve and migraines/dry eye.

Central Sensitization: This is a condition which occurs when the central nervous system becomes overreactive to some stimuli like noise, light, or touch. This can lead to more intense pain along with lower pain tolerance. Central sensitization is also associated with many chronic pain conditions, including migraines, and it may also be present in people with dry eye, and can be the reason people experience eye pain from things like light, wind, or cold.

Genetics: Genetic components have been identified in both dry eye and migraines, and they often run in families. Dry eye syndrome in particular has also been genetically linked to things like chronic pelvic pain, fibromyalgia, and IBS.

Shared Symptoms

Among the other connections between headaches and dry eye, they share two common symptoms.

Eye Pain

Anyone who has migraines will be familiar with the eye pain you might feel in, around, or behind the eyes. Dry eye also can cause eye pain, with a grittier, irritated, burning sensation. Learn more about it here.

Photophobia

Photophobia, or light sensitivity, is eye discomfort or pain when exposed to light. Around 80% of people who suffer from migraines experience photophobia, and most people with dry eye also report this symptom. Learn more about it here.

One Can Affect the Other
A Deeper Look at Connections

Additional Similarities

There are some other things that dry eye and migraines have in common along with the symptoms mentioned above.

These include:

Shared comorbidities: Both of these conditions are found to be comorbid with fatigue, anxiety, depression, sleep disorders, and other conditions with chronic pain.

Somatosensory dysfunction: Somatosensory dysfunction is a faulty response in the way the brain perceives neural impulses. These dysfunctions include hypoesthesia (experiencing less sensation or sensitivity to regular stimuli), hyperalgesia (feeling more pain than normal from anything which causes pain), and allodynia (when one feels pain from something that does not normally cause pain.) This is found in people experiencing both headaches and dry eye.

Females are primarily affected: Dry eye and migraines (along with other chronic pain conditions) are significantly more common among women.

Disconnect between signs and symptoms: While both of these conditions present symptoms, there may not be obvious clinical signs that indicate a direct physical cause of the problems (like structural problems or nerve damage.)

Lower quality of life: Both dry eye and chronic headaches can negatively impact your quality of life, making everyday activities like reading, watching tv, or driving more difficult and uncomfortable.

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Common Questions

Depending on the severity and type of dry eyes (aqueous or evaporative) there are various ways we can treat dry eyes. Initially we would start off the patient to use warm compresses 2x a day for 10 minutes with lid massage and lid scrubs. Along with the use of over the counter artificial tears 2-4x a day in both eyes. Depending on severity we can also add a gel drop or ointment at night. If relief is still not occurring with the initial course of treatment, we can then add prescription eye drops for dry eyes such as Restasis or Xiidra. Other dry eye treatment options are using punctal plugs or other devices like Lipiflow/iLux/IPL etc.
Some symptoms of dry eyes are that your eyes may feel gritty, irritated, scratchy, foreign body sensation, burning, excessive watering/tearing, redness, or you may experience light sensitivity. Other symptoms may include blurry vision; you may notice you find yourself blinking more frequently in order for your vision to get cleared up, after going in and out of focus, due to an unstable ocular surface.
Can Dry Eyes Cause Headaches?
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Summary

Dry eyes and headaches (specifically migraines) are often found together, and have many similarities, though one does not necessarily cause the other. If you are experiencing chronic headaches and dry eye, you should see a doctor as soon as possible so you can receive more information on what may be causing them and what can be done to correct the problem. If you are experiencing dry eye or chronic migraines, or have other questions, you can reach out to your nearest Amplify EyeCare practice either via a call or in-person visit to schedule an appointment for an eye exam. Our team of eye care professionals is ready and equipped to provide you with the care you need. 

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