Headaches are just a fact of life in clinical optometry. As a matter of fact, headaches are one of the most commonly reported symptoms in eye care. Headaches are mostly unavoidable and nearly undiagnosable.

Oh, I almost forgot. Sometimes patients have headaches, too.

As a matter of fact, nearly everyone in the whole world experiences some form of headache. The majority are related to whom you are related…to. Nothing can trigger head pain like your daughter’s first tattoo or your son’s most recent speeding ticket. And, wanna understand what it feels like to be hit by a golf ball between the eyes? Try to make a bed to my wife’s specifications sometime.

But, work-related headaches are a close second. I have very specific headaches for very specific patients. For instance:

Patient: “I get a headache when I wear my new glasses.”

Me: “I get a headache when you speak.”

Fortunately, after 32 years of practice, my patients always think I am just funnin’ with them.


An Occupational Hazard
Sometimes weather gives me a headache. No, not when a cold front or snow approaches. My headache comes on when it’s sunny and mild. I get one when no one shows up—unless, of course they “get a headache when they wear their new glasses.” Oh, that patient is always on time.

I have found a few ways to soothe my optometric brain pain. For example, I go to the chiropractor once per month for an adjustment whether I need it or not. OK, I always need it. My chiropractor is my patient. He never wears his glasses. He explained to me that he really doesn’t need glasses, so he only wears them when he wants to see something. Glad he’s not an airline pilot. Of course, he once adjusted my briefcase instead of my back but I was able to talk him into a discount, so all was forgiven.

Doctors, headaches are just a part of your life, which can only be avoided if you just choose a profession where you never deal with any human beings. Or if you avoid their sensory organs at least, as patients can be quite demanding when you mess with those. If a patient can’t see, it’s really your fault, after all… I love it when they come in and announce, “My glasses have changed.”

Sure, their glasses changed. Pass the acetaminophen!

What if the patient has the headache? Here’s my simple, two-step technique for differential diagnosis:

1. Do they have an arrow sticking out of their head AND the headache started right when the arrow hit them in the head AND the headache is located right where the arrow hit them in the head AND this happens every time an arrow hits them in the head in that specific location? If so, there is a 50% chance that the cause is the arrow.

2. Do they have headache with associated nausea, blurred vision, photophobia, photopsias and scotomata? Then there is a 50% chance the cause is still the arrow, even if there is no history of any arrows. The other possibility is the patient is your mom and you are on vacation when she calls.

Maybe you just need to change your mindset. From now on, if your head hurts, it means you are fine. If your head stops hurting, go to the ER because something is horribly wrong with you.