Excruciating Orbital Pain

I am a 29 year old female. I have had sharp headaches, toothpick like, for as long as I can remember. I had pain behind my eyeball, that made me want to rip my eyeball out, in march of this year for 8 weeks. It went away for a month or so and then came back in July. I saw an optometrist and was prescribed glasses for astigmatism. They also did a digital picture of my eye to check the arteries/veins behind my eye. The glasses have not helped. The pain comes and goes but is affecting my quality of life greatly! I have had CT scans and MRI scans as well. I will give all "positive" findings... MRA Brain 6/14/10: Minimal RIGHT P1 segment hypoplasia but impression was unremarkable MRI/MRA brain. CT Brain 11/5/10 after slip and fall: Mild opacity within a couple of bilateral ethmoid air cells. Area of hyperostosis immediately adjacent to the left IAC, perhaps idiopathic, other possibility being indirect evidence of lesion such as meningioma. No definite mass in this location on the prior MRI from June. MRI Brain/IAC 11-12-10: Single opacified LEFT ethmoid air cell. Small focal hyperostosis along posterior wall of the LEFT IAC and contacts the vestibular nerve, could be developmental or due to benign dural calcification. No neural compression or displacement appreciated. MRI/MRA Brain 3-28-11 Questionable small arachnoid cyst in the LEFT cerebellopontine angle cistern measuring 13 mm x 8 mm. Mild ethmoid sinus mucosal thickening. RIGHT posterior communicating artery is prominent, as before. There is questionable subtle fenestration of the proximal basal artery.

I have seen a neurologist, 2 optometrists, and had all these studies done and do not have an answer of the orbital pain. I also get very tense in my shoulder that goes up my neck and into the back of my head. Sometimes it happens after the orbital pain. I am in desperate need of answers!!

[Christopher R Newey, DO]

Thanks for using the forum. I am happy to address your questions, and my answer will be based on the information you provided here. Please make sure you recognize that this forum is for educational purposes only, and it does not substitute for a formal office visit with a doctor.

Without the ability to examine and obtain a history, I can not tell you what the exact cause of the symptoms is. However I will try to provide you with some useful information.

Headaches can present in different ways and be caused by different mechanisms (for example primary headache such as a migraine or a secondary headache such as from a tumor). Primary headache disorders are much more common than secondary ones. There are several primary headache disorders, over 50 different types.  For example migraines present as a pulsating throbbing one-sided pain with nausea and discomfort in bright lights that lasts several hours. Another type is cluster headaches, which are sharp pains that occur around and behind the eye often at night and are associated with tearing of the eye and running of the nose. In primary stabbing headache, sharp or jabbing pain in the head occur, either as a single stab or a series of brief repeated volleys of pain. Primary stabbing headache often occurs in people with migraine. The pain itself generally lasts a fraction of a second but can last for up to one minute in some people. Another type of stabbing headache is called paroxysmal hemicrania. This is marked by episodes of stabbing or sharp pains that occur on one side of the head and may be associated with eye tearing or runny nose. Episodes may occur several times and last 30 seconds to a minute. Yet another type of stabbing headache is abbreviated SUNCT; 100s of stabbing pains lasting seconds occur and are associated with red eye and tearing.

I would suggest you follow up with a neurologist who specializes in headache disorders. Each headache type has different treatment options.

Thank you for this opportunity to answer your questions, I hope you find the information I have provided useful, good luck.

[ExcruciatingPain]

LEFT eye! Sorry, I forgot to include that in there!!

[tiredofpain720]

i have occipital neuralgia and this sounds pretty close to what i experience when having an attack. i would research it and if it sounds close to your symptoms mention it to one of your neuro docs. im pretty sure they would agree with me. regular pain meds dont work for the pain..i.e. vicodin,dilaudid,demarol. you need a nerve med such as tegretol,or trileptal to help with the pain. i hope this helps some.