Angle closure glaucoma can cause severe headache, nausea, and halos around lights, so it can look like migraine. A gonioscopy exam checks your drainage angle, and a laser iridotomy can treat narrow angles when needed.
She came for a routine eye check. She was in her late forties or early fifties. She had no eye complaints. She wanted to know whether her glasses needed a small change.
During the examination, I noticed that the front chamber of her eyes was shallow. I explained that I needed to look at her drainage angles with a gonioscopy. I asked if she had headaches or saw coloured haloes around light bulbs.
She began to talk. For seven to eight years, she had lived with migraines. She had tried treatment after treatment and seen specialist after specialist. The headaches kept coming.
I placed a gonioscope on each eye. It is a contact lens with a mirror that shows the drainage angle directly. Both angles were narrow. In roughly a quadrant of each eye, parts of the angle had already stuck shut. Her eye pressure measured 22 to 24 mmHg. [ADD: one sentence on optic nerve and visual field status.]
We treated [both eyes] with a laser peripheral iridotomy in the clinic. That was ten years ago. She tells me she has had no migraine attacks since. She still gets an occasional headache.
Years of treatment had focused on her head. Her drainage angles had not been examined until that day.
Patient details have been changed to protect privacy.
Her case teaches a careful lesson. Most migraines have nothing to do with the eyes. But narrow angles can cause attacks that look like migraine, and a headache workup does not check for them. If years of treatment have not worked, your tiredness is real. Below, I explain how angle closure mimics migraine, how to tell the clues apart, which migraine medicines can trigger it, and when an eye examination is urgent.
How Angle Closure Glaucoma Mimics Migraine
Angle closure glaucoma can look like migraine because the symptoms overlap. The drainage angle is the gap where fluid leaves the eye. In angle closure, this gap narrows or blocks, and eye pressure rises. In intermittent angle closure, the angle blocks for a while and then reopens. The pressure falls, and the attack passes.
During an attack, a patient may have severe throbbing headache, nausea, vomiting, eye redness, and an ache around the eye. In some people, the headache is the only symptom. Haloes appear because the cornea swells when pressure rises. Attacks often start in dim light or in the evening, when the pupil widens. The International Headache Society lists angle closure as a cause of secondary headache. [CITE 1]
Between attacks, narrow angles cause no symptoms. The eye can look normal and see well. Only an examination with gonioscopy can find them. A full attack, called acute angle closure, is an emergency.
Doctors grade angle closure in three steps. Narrow angles alone are called primary angle closure suspect. Narrow angles with adhesions or raised pressure are primary angle closure. Add optic nerve damage, and it becomes primary angle closure glaucoma. Her eyes had adhesions and raised pressure, so she had primary angle closure.
How to Tell Migraine From Angle Closure
| Symptom | What It Suggests | What To Do |
|---|---|---|
| Headache with haloes around lights, seen with eyes open | Corneal swelling from raised pressure | Ask an eye doctor for gonioscopy and a pressure check within the week |
| Zigzag or shimmering lights that stay when you close your eyes | Migraine aura, which comes from the brain | Tell your neurologist. Ask for an eye check if eye pain also occurs |
| Headache with red eye and ache around the socket | Possible raised eye pressure | Go to an eye emergency the same day if the pain is severe |
| Attacks start in dim light or in the evening | A widened pupil may narrow the angle | Ask your eye doctor about narrow angles and gonioscopy |
| Blurred vision that clears after the headache | Temporary corneal swelling | Book an eye exam this week. Go the same day if vision does not clear |
| Migraine treatment is failing and your angles were never checked | Narrow angles are one possible missed cause | Ask a glaucoma specialist for gonioscopy |
| New eye pain or blur after starting topiramate | Drug-induced angle closure is possible | Seek same-day emergency eye care and tell your prescribing doctor |
Why is Angle Closure Missed
A headache workup does not include gonioscopy. It is a specialist test. Neurologists and physicians do not carry gonioscopes. That is a gap in the system, not a failing of those doctors.
The symptoms fit migraine, so the label sticks. Both can start suddenly, and both can bring nausea.
Some patients mention haloes. Not every doctor follows up with an eye examination.
Narrow angles are silent between attacks. Good vision and a quiet eye give false reassurance. Routine eye checks, including many glasses checks, do not always include gonioscopy.
Migraine Medicines and Angle Closure
Some medicines can trigger angle closure in vulnerable eyes. Topiramate, sometimes used to prevent migraine, can cause sudden angle closure, often in both eyes. Drops that widen the pupil can also set off an attack in narrow angles. Tell your doctor if anyone has told you your angles are narrow. Do not stop a prescribed medicine on your own.
What Laser Peripheral Iridotomy Does and Does Not Do
A laser peripheral iridotomy (LPI) makes a tiny opening in the iris. Fluid can then pass through it. This relieves the blockage that narrows the angle. We do it in the clinic, and it usually takes under ten minutes. There is no incision and no general anaesthesia.
LPI treats the angle. It does not treat migraine itself. Her attacks stopped after LPI. That is one patient’s experience, not proof that LPI treats migraine.
LPI lowers the risk of angle closure in narrow-angle eyes. A large randomised trial in China showed this. Some eyes still need drops or surgery, especially when adhesions or optic nerve damage are present. Common effects are brief blur, glare, and a short pressure rise. Some patients notice a thin arc of light.
When To See an Eye Specialist for Headaches
See a Doctor Urgently
- Sudden eye pain with redness and blurred vision
- Severe headache with nausea, vomiting, and haloes around lights
- New eye pain or blur after starting topiramate
- A sudden “worst ever” headache, weakness, trouble speaking, or confusion. Go to an emergency room. This may not be an eye problem.
See a Glaucoma Specialist
- Recurring headaches have not responded to treatment, and your angles were never examined
- Your headaches come with haloes or eye ache
- You have a family history of angle closure
- You are significantly long-sighted
Frequently Asked Questions
Can angle closure glaucoma cause headaches that feel like migraine?
Yes, in some people. Intermittent angle closure can cause throbbing headache, nausea, vomiting, eye redness, and haloes around lights. These overlap with migraine, so the cause can be missed for years. A gonioscopy exam checks the drainage angle. Most migraines are not caused by the eye, but your doctor can rule this out.
What is a laser peripheral iridotomy, and is it a major procedure?
It is a minor laser procedure done in the clinic, usually in under ten minutes. The laser makes a tiny opening in the iris so fluid can flow freely. There is no incision, no hospital stay, and no general anaesthesia. Most patients resume normal activity the same day. Some notice brief blur or glare afterwards.
Can a laser iridotomy cure my migraines?
Not in general. Laser iridotomy treats narrow angles, not migraine itself. If narrow angles were triggering your headaches, the laser may reduce them. One patient of mine had no migraine attacks for ten years afterwards. That is one patient, so your result may differ.
Who should have their drainage angles checked?
Ask for gonioscopy if you have a family history of angle closure or are significantly long-sighted (hypermetropic). Risk is also higher in people over 40, in women, and in people of East or South Asian descent. Ask too if you have recurring headaches with haloes or eye ache that treatment has not helped. Narrow angles cause no symptoms between attacks, so a normal-looking eye does not rule them out.
Book a Consultation
Book if migraines or headaches with haloes or eye ache have not responded to treatment and your drainage angles have never been checked. Book too if you have a family history of angle closure or are significantly long-sighted.
At my clinic in Gurgaon, I will check your eye pressure and examine your drainage angles with gonioscopy. I will explain whether you have narrow angles and whether laser treatment makes sense. Gonioscopy needs an in-person visit. If you live elsewhere, I can review your reports first and work with your local eye doctor.
Book an Appointment:
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Further Reading
- My article for NDTV: When Is A Headache Really About Your Eyes? An Ophthalmologist Explains
- Headache Behind the Eye: Migraine, Pressure, or Something Else?
- Migraine and Eye
- Yuan et al., Zhongshan Angle Closure Prevention (ZAP) trial. Please also read about Laser Treatments for Glaucoma, Narrow Angles and Gonioscopy.
- Rajjoub et al. Intermittent acute angle closure glaucoma and chronic angle closure following topiramate use with plateau iris configuration.
This page is a part of the Glaucoma Hub. you may want to read about Glaucoma Progression, , and Risk Stratification in Glaucoma. Other articles of interest could be Advanced Glaucoma Care in Gurgaon, What Good Glaucoma Care Actually Optimises For, What Happens If Glaucoma Is Left Untreated?, More Glaucoma Eye Drops is Not Better Glaucoma Care, 5 Mistakes Patients Make in Glaucoma Care and Do You Really Need Treatment for Glaucoma?
This page is part of the Neuro-Ophthalmology hub. Read about our full approach to neurological vision conditions. Some vision problems are not eye problems. They are brain problems, nerve problems, or vascular problems, that show up in the eye first. Also read about optic nerve disease, AION and NAION, raised intracranial pressure, Vision not clear but tests normal, double vision, and conditions where no diagnosis has yet been reached. Please also read neuro-ophthalmology second opinion, and guidelines for neuro-ophthalmology consults.
You may want to watch this podcast I did several years ago, for Health Talks.
About the Author
This article was written by Dr Shibal Bhartiya, fellowship-trained glaucoma specialist and Mayo Clinic Research Collaborator, Clinical Director at Marengo Asia Hospitals, Gurugram, known for ethical, patient-centred glaucoma care and independent glaucoma second opinions. She is also the Program Director for Community Outreach & Wellness; and for the Marengo Asia International Institute of Neuro and Spine.
Dr Bhartiya has published peer-reviewed research onglaucoma management, examining how treatment decisions should balance medical evidence, patient preferences, and long-term vision outcomes. She is also a committed patient advocate and mainstream medical columnist, translating complex ophthalmic evidence into actionable public health insights across leading national platforms including NDTV and OnlyMyHealth
As Editor-in-Chief of Clinical and Experimental Vision and Eye Research and Executive Editor of the Journal of Current Glaucoma Practice (Pubmed Indexed, official journal of the International Society of Glaucoma Surgery), Dr Shibal Bhartiya brings editorial and research depth to every clinical decision. Her 200+ publications, including 90+ PubMed-indexed publications and 28 edited textbooks span glaucoma biology, surgical outcomes, health equity, and emerging diagnostics.
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Last Reviewed: 10 October 2026
