When headache meets visual disturbance: An evidence-based review of common and critical entities

Concurrent headache and visual symptoms pose a diagnostic challenge across specialties, ranging from benign to life-threatening etiologies. Overlapping manifestations and terminological confusion often lead to misdiagnosis and delayed care. This narrative review searched eight databases from inception to May 5th, 2026, for articles on headache and visual symptoms. Extracted data were synthesized into a structured diagnostic framework. Key benchmarks were clarified across seven categories. Retinal migraine and migraine with aura are distinguished by monocular/binocular involvement, duration, and stroke risk. Visual snow syndrome is confirmed as a persistent disorder distinct from migraine aura. Life-threatening vascular emergencies—including giant cell arteritis, posterior reversible encephalopathy syndrome, subarachnoid hemorrhage, cerebral venous sinus thrombosis, and arterial dissection—exhibit unique red-flag patterns and imaging features. Intracranial pressure disorders present with pressure-dependent headaches. Optic neuritis subtypes (MS-associated, MOGAD, NMOSD) differ significantly in visual impairment, imaging lesions, treatment response, and prognosis. Occipital lobe epilepsy is differentiated by ultra-short visual hallucinations with ictal activity. Additional ophthalmic, structural, and infectious etiologies further broaden the differential spectrum. This evidence-based framework standardizes clinical differentiation of headache with visual symptoms. Emphasizing key historical features, red-flag signs, advanced imaging biomarkers, and antibody testing enables accurate classification, timely intervention, prevents irreversible vision loss and fatal complications, and optimizes long-term prognosis. © The Author(s) 2026. This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage).