Throbbing Eye Pain

Is it the eye or a headache?

Most throbbing eye pain is actually headache pain felt in the eye. The trigeminal nerve carries pain from both the eye and much of the head, so the brain cannot always tell where pain begins.

Causes of throbbing eye pain

Migraine

Migraine often causes a throbbing pain behind or around one eye, lasting 4 to 72 hours, with nausea and sensitivity to light and sound. Some people have a visual aura first. Pain is worse with movement.

Cluster headache

Cluster headache causes excruciating, one-sided pain around or behind one eye, lasting 15 minutes to 3 hours, often at the same time each day or night. The eye on that side waters and reddens, the eyelid droops, and the nose runs. People pace or rock rather than lie still. Attacks come in clusters lasting weeks, often in the same season.

Sinusitis

Acute sinusitis causes pressure or throbbing behind the eyes and across the cheeks and forehead, worse when bending forward, with a blocked nose and discolored mucus. Many "sinus headaches" are actually migraines.

Eye strain

Long periods of reading or screen use, uncorrected vision problems or poor lighting cause aching around the eyes and forehead that improves with rest. See eye strain.

Acute angle-closure glaucoma

The drainage angle of the eye suddenly closes and eye pressure rises sharply. Symptoms are severe throbbing eye pain, headache, a red eye, blurred vision, halos around lights, nausea and vomiting. It is more common in farsighted people, older adults and people of East Asian descent, and can be triggered by dim light or medicines that dilate the pupil. Without treatment within hours, it can cause permanent vision loss. See acute glaucoma.

Scleritis

Scleritis is inflammation of the white outer coat of the eye. It causes a severe, deep, boring pain that often radiates to the forehead and jaw, wakes people at night and is tender to touch. The eye is red, sometimes with a purplish tinge. About half of cases are linked to autoimmune diseases such as rheumatoid arthritis.

Uveitis

Uveitis causes an aching, red eye with light sensitivity and blurred vision.

Optic neuritis

Inflammation of the optic nerve causes pain behind the eye, worse with eye movement, and loss of vision or color vision over days. See optic neuritis.

Other causes

• Giant cell arteritis in people over 50: temple pain, scalp tenderness, jaw pain when chewing and risk of sudden vision loss
• Orbital cellulitis: infection around the eye with fever, swelling and painful eye movements
• Trigeminal neuralgia (brief electric shocks rather than throbbing)
• High blood pressure crisis, rarely
• Brain aneurysm pressing on a nerve, with a drooping lid and enlarged pupil (rare)

How doctors diagnose the cause

A doctor or eye specialist will check visual acuity, look at the pupils, measure eye pressure, examine the eye with a slit lamp and look at the optic nerve. They will ask about headache patterns, triggers, sinus symptoms and other illnesses. Further tests may include blood tests for inflammation (ESR and CRP for giant cell arteritis), an MRI of the brain and orbits, or a CT of the sinuses.

Treatment

• Migraine: rest in a dark room, NSAIDs or acetaminophen (paracetamol) following the label, triptans and preventive treatment for frequent attacks.
• Cluster headache: high-flow oxygen and triptan injections or nasal sprays are the main acute treatments, plus preventive medicines.
• Sinusitis: saline rinses, steroid nasal sprays, pain relief, and antibiotics only for bacterial cases.
• Acute glaucoma: emergency eye drops and medicines to lower pressure, then laser treatment (iridotomy), usually to both eyes.
• Scleritis and uveitis: anti-inflammatory and steroid treatment, and treatment of any underlying disease.
• Eye strain: the 20-20-20 rule, correct glasses and good lighting.

Frequently asked questions

What causes throbbing pain behind one eye?

The most common causes are migraine and cluster headache, which typically affect one side. Sinusitis, eye strain and optic neuritis are other causes. If the eye is red, vision is blurred, or you see halos or are vomiting, get emergency care to rule out acute glaucoma.

Can high blood pressure cause throbbing eye pain?

Ordinary high blood pressure usually causes no symptoms. Very high blood pressure in a hypertensive crisis can cause headache, eye pain and blurred vision and is an emergency. Most throbbing eye pain has other causes such as migraine or sinusitis.

Is throbbing eye pain a sign of glaucoma?

Most glaucoma is painless and develops slowly. Acute angle-closure glaucoma is the exception: it causes sudden, severe eye pain with redness, blurred vision, halos and vomiting. That combination is an emergency because sight can be lost within hours.

How do I relieve throbbing eye pain at home?

For a known migraine or eye strain, rest in a dim room, use a cool compress, take an OTC pain reliever following the label, and take screen breaks. If pain is new, severe, or comes with a red eye or vision changes, see a doctor instead of treating it at home.