Der Ophthalmologe

, Volume 108, Issue 12, pp 1120–1126 | Cite as

Augenschmerzen aus neurologischer Sicht

  • O. Kastrup
  • H.-C. Diener
  • C. Gaul


Viele Patienten mit neurologischen Störungen leiden an Kopf- oder Gesichtsschmerzen. Häufig ergeben sich klinisch Überlappungen mit differenzialdiagnostisch zu erwägenden ophthalmologischen Erkrankungen. Die Therapie chronischer Gesichts- und Kopfschmerzen sollte durch einen schmerztherapeutisch erfahrenen Neurologen erfolgen. Bei wiederkehrenden ins Auge projizierten Schmerzen handelt es sich häufig um Schmerzen, denen nicht unbedingt eine morphologische Schädigung an Auge oder Orbita zugrunde liegt. Symptomatische Kopf- und Gesichtsschmerzen können auch durch Gefäßprozesse im Kopf-Hals-Bereich ausgelöst werden. Aus diesem Grund ist eine differenzialdiagnostische Einordnung einer möglichen symptomatischen Schmerzursache unbedingt erforderlich. Ein vom Augenarzt morphologisch nicht erklärlicher Schmerz an Auge und Orbita sollte Anlass zu einer neurologischen Vorstellung geben. Bei episodischen Augenschmerzen kann der Neurologe anhand weiterer Symptomkonstellationen ggf. ein idiopathisches Kopf- oder Gesichtsschmerzsyndrom identifizieren und adäquat therapieren. Bei chronischen und persistenten Beschwerden sowie weiteren pathologischen körperlichen Befunden im neurologischen Untersuchungsbefund ist eine weitere bildgebende, elektrophysiologische oder liquorchemische Diagnostik erforderlich. Die Vielzahl von symptomatischen Augen- und Orbitaschmerzen, bedingt durch intrakranielle Pathologien, erfordert eine hohe differenzialdiagnostische Wachsamkeit.


Augenschmerz Neurologie Behandlung Kopfschmerzen Gesichtsschmerzen 

Facial and eye pain – Neurological differential diagnosis


Head and facial pain are common in neurological practice and the pain often arises in the orbit or is referred into the eye. This is due to the autonomic innervation of the eye and orbit. There are acute and chronic pain syndromes. This review gives an overview of the differential diagnosis and treatment. Idiopathic headache syndromes, such as migraine and cluster headache are the most frequent and are often debilitating conditions. Trigemino-autonomic cephalalgias (SUNCT and SUNA) have to be taken into account, as well as trigeminal neuralgia. Trigemino-autonomic headache after eye operations can be puzzling and often responds well to triptans. Every new facial pain not fitting these categories must be considered symptomatic and a thorough investigation is mandatory including magnetic resonance imaging. Infiltrative and neoplastic conditions frequently lead to orbital pain. As a differential diagnosis Tolosa-Hunt syndrome and Raeder syndrome are inflammatory conditions sometimes mimicking neoplasms. Infections, such as herpes zoster ophthalmicus are extremely painful and require rapid therapy. It is important to consider carotid artery dissection as a cause for acute eye and neck pain in conjunction with Horner’s syndrome and bear in mind that vascular oculomotor palsy is often painful. All of the above named conditions should be diagnosed by a neurologist with special experience in pain syndromes and many require an interdisciplinary approach.


Eye pain Neurology Treatment Headache Facial pain 



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  1. 1.
    Bendtsen L, Evers S, Linde M et al (2010) EFMS Guideline on the treatment of tension-type headache – report of an EFNS task force. Eur J Neurol 17:1318–1325PubMedGoogle Scholar
  2. 2.
    Bennetto L, Patel NK, Fuller G (2007) Trigeminal neuralgia and its management. BMJ 334:201–205PubMedCrossRefGoogle Scholar
  3. 3.
    Chakravarthi PS, Ghanta R, Kattimani V (2011) Mikrovaskular decompression treatment for trigeminal neuralgia. J Craniofac Surg 22:894–898PubMedCrossRefGoogle Scholar
  4. 4.
    Chan CC, Paine M, O’Day J (2001) Carotid dissedtion: a common cause of Horner’s syndrome. Clin Experiment Ophthalmol 29:411–415PubMedCrossRefGoogle Scholar
  5. 5.
    Cohen AS (2007) Short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing. Cephalalgia 27:824–832PubMedCrossRefGoogle Scholar
  6. 6.
    Colnaghi S, Versino M, Marchioni E et al (2008) ICHD-II diagnostic criteria for Tolosa-Hunt syndrome in idiopathic inflammatory syndromes of the orbit and/or the cavernous sinus. Cephalalgia 28:577–584PubMedCrossRefGoogle Scholar
  7. 7.
    Debette S, Leys D (2009) Cervical-artery dissections: predisposing factors, diagnosis, and outcome. Lancet Neurol 8:668–678PubMedCrossRefGoogle Scholar
  8. 8.
    Evers S, May A, Fritsche G et al (2008) Akuttherapie und Prophylaxe der Migräne. Nervenheilkunde 27:933–949Google Scholar
  9. 9.
    Favier I, Vliet JA van, Roon Kl et al (2007) Trigeminal autonomic cephalgias due to structural lesions: a review of 31 cases. Arch Neurol 64:25–31PubMedCrossRefGoogle Scholar
  10. 10.
    Freilinger T, Dichgans M (2006) Genetik der Migräne. Nervenarzt 77:1188–1195CrossRefGoogle Scholar
  11. 11.
    Gaul C, Sandor PS, Galli U et al (2007) Orofacial migraine. Cephalalgia 27:950–952PubMedCrossRefGoogle Scholar
  12. 12.
    Gaul C, Hastreiter P, Duncker A, Naraghi R (2011) Diagnosis and neurosurgical treatment of glossopharyngeal neuralgia: clinical findings and 3-D visualization of neurovascular compression in 19 consecutive patients. J Headache Pain 12:527–534PubMedCrossRefGoogle Scholar
  13. 13.
    Gaul C, Doorn C von, Webering N et al (2011) Clinical outcome of a headache-spezific multidisciplinary treatment program and adherence to treatment recommendations in a tertiary headache center: an observational study. J Headache Pain 12:475–483PubMedCrossRefGoogle Scholar
  14. 14.
    Gaul C, Diener HC, Müller OM (2011) Clusterkopfschmerz. Klinisches Bild und therapeutische Optionen. Dtsch Arztebl Int 108:543–549PubMedGoogle Scholar
  15. 15.
    Goadsby PJ, Cittadini E, Cohen AS (2010) Trigeminal autonomic cephalalgias: paroxysmal hemicrania, SUNCT/SUNA and hemicrania ontinua. Semin Neurol 30:186–191PubMedCrossRefGoogle Scholar
  16. 16.
    Headache Classification Subcommittee of the International Headache Society (2004) The international classification of headache disorders. Cephalalgia 24:9–160CrossRefGoogle Scholar
  17. 17.
    Kaube H, Herzog J, Käufer T et al (2000) Aura in some patients with familial hemiplegic migraine can be stopped by intranasal ketamine. Neurology 55:139–141PubMedGoogle Scholar
  18. 18.
    Katsarava Z, Haag G, Lampl C et al (2007) Therapie primärer chronischer Kopfschmerzen: Chronische Migräne, chronischer Kopfschmerz vom Spannungstyp und andere chronische tägliche Kopfschmerzen. Nervenheilkunde 26:186–199Google Scholar
  19. 19.
    La Mantia L, Curone M, Rapoport AM et al (2006) Tolosa-Hunt syndrome: critical literature review based on HIS 2004 criteria. Cephalalgia 26:772–781CrossRefGoogle Scholar
  20. 20.
    Lampl C, Katsarava Z, Diener HC, Limmroth V (2005) Lamotrigine reduces migraine aura and migraine attacks in patients with migraine with aura. J Neurol Neurosurg Psychiatry 76:1730–1732PubMedCrossRefGoogle Scholar
  21. 21.
    Levin M, Ward TN (2004) Ophthalmoplegic migraine. Curr Pain Headache Rep 8:306–309PubMedCrossRefGoogle Scholar
  22. 22.
    Lyerly MJ, Peterson BW, Lara AK, McGrath TM (2011) Ophthaloplegic migraine. Headache 10:1526–4610Google Scholar
  23. 23.
    Maggioni F, Dainese F, Mainardi F et al (2005) Cluster-like headache after surgical crystalline removal and intraocular lens implant: a case report. J Headache Pain 6:88–90PubMedCrossRefGoogle Scholar
  24. 24.
    May A, Leone M, Afra J et al (2006) EFNS guidelines on the treatment of cluster headache and other trigeminal-autonomic caphalalgias. Eur J Neurol 13:1066–1077PubMedCrossRefGoogle Scholar
  25. 25.
    May A, Gamulescu MA, Bogdahn U, Lohmann CP (2002) Intractable eye pain: indication for triptans. Cephalalgia 22:195–196PubMedCrossRefGoogle Scholar
  26. 26.
    Miranda M, Venegas P, Kagi M (2003) Blindness caused by an ischemic optic neuropathy by spontaneous carotid dissection. Report of a case. Rev Med Chil 131:1042–1044PubMedGoogle Scholar
  27. 27.
    Obermann M, Yoon MS, Dommes P et al (2007) Prevalence of trigeminal autonomic symptoms in migraine: a population-based study. Cephalalgia 27:504–509PubMedCrossRefGoogle Scholar
  28. 28.
    Pavan-Langston D (2008) Herpes zoster antivirals and pain management. Ophthalmology 115:13–20CrossRefGoogle Scholar
  29. 29.
    Ringeisen AL, Harrison AR, Lee MS (2011) Ocular and orbital pain for the headache specialist. Curr Neurol Neurosci Rep 11:156–163PubMedCrossRefGoogle Scholar
  30. 30.
    Rozen TD (2001) Antiepileptic drugs in the management of cluster headache and trigeminal neuralgia. Headache 41(Suppl 1):25–32CrossRefGoogle Scholar
  31. 31.
    Salvesen R (1999) Raeder’s syndrome. Cephalalgia 25:42–45Google Scholar
  32. 32.
    Sanjay S, Huang P, Lavanya R (2011) Herpes zoster ophthalmicus. Curr Treat Options Neurol 13:79–91PubMedCrossRefGoogle Scholar
  33. 33.
    Schoser BG (2007) Ocular myositis: diagnostic assessment, differential diagnoses, and therapy of a rare muscle disease – five new cases and review. Clin Ophthalmol 1:37–42PubMedGoogle Scholar
  34. 34.
    Shoja MM, Tubbs RS, Ghabili K et al (2010) Johan Georg Raeder (1889–1959) and paratrigeminal sympathetic paresis. Childs Nerv Syst 26:373–376PubMedCrossRefGoogle Scholar
  35. 35.
    Sjaastad O, Bakketeig LS, Petersen HC (2006) Migraine with aura: visual disturbances and interrelationship with the pain phase. Vaga study of headache epidemiology. J Headache Pain 7:127–135PubMedCrossRefGoogle Scholar
  36. 36.
    Sörös P, Vo O, Gerding H et al (2005) Enucleation and development of cluster headache: a retrospective study. BMC Neurol 5:6PubMedCrossRefGoogle Scholar
  37. 37.
    Tay E, Gibson A, Chaudhary N, Olver J (2008) Idiopathic orbital inflammation with extensive intra- and extracranial extension presenting as 6th nerve palsy – a case report and literature review. Orbit 27:458–461PubMedCrossRefGoogle Scholar
  38. 38.
    Wilker SC, Rucker JC, Newman NJ et al (2009) Pain in ischaemic ocular motor cranial nerve palsies. Br J Ophthalmol 93:1657–1659PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  1. 1.Neurologische Universitätsklinik EssenEssenDeutschland

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