11.3.1 Headache attributed to acute angle-closure glaucoma

Identification: Female patient, 65 years old, hyperopic, with a history of sudden ocular pain and severe headache for 6 hours.

History of Present Illness:
Sudden onset of intense unilateral (right) ocular pain, stabbing in nature, radiating to the ipsilateral frontal and temporal regions.

Associated ocular symptoms:
Blurred vision and halos around lights.
Conjunctival hyperemia and nausea/vomiting.

Triggering factors: Recent history of mydriatic use (tropicamide eye drops) for fundoscopic examination.

No prior history of migraine or primary headaches.

Physical and Neurological Examination:
Ocular examination:

Right eye:
Conjunctival hyperemia, edematous cornea (hazy appearance).
Mydriatic pupil (5 mm), non-reactive to light.
Elevated intraocular pressure (IOP): 52 mmHg (normal: 10-21 mmHg).

Left eye: Normal IOP (14 mmHg), narrow angle on gonioscopy.

Neurological examination: No focal deficits or meningeal signs.

Complementary Exams:
Gonioscopy (right eye): Closed anterior chamber angle (Shaffer grade 0).
Biomicroscopy: Corneal edema, shallow anterior chamber.
Visual field (after resolution): Peripheral defect suggestive of glaucoma.