Hi. I'm online and happy to answer your question today.
Good morning. Any thoughts?
It is possible that he has sinus issues along with his migraine however, as you know migraines can also cause eye pain along with periorbital pain.
Ok this is the first pain that has woken him up. What do you suggest?
It would be unusual for him to have a sudden onset of acute eye pain related to an intraocular process since he has no history of eye issues. Given his history of migraines I would look to that as a cause first.
Should we see a neurologist?
I do not like that the pain has woken him up, that is true. Have you noticed any difference in his pupils, his eye movements or has he complained of any vision problems (outside of the usual multicolored lights that may precede his headache)?
If this is the first time a headache has woke him up, a visit to a neurologist would not hurt.
His eyes are not dialated and no eye movement problems.
Then I do not think it is an emergency that he be seen -- no need for a trip to the ER. However, if he starts to become confused, show any systemic signs or if he just "doesn't seem right" to you then I'd get in him in ASAP.
Thank you and happy holidays!
Otherwise, I think this is most likely a bad migraine and will run its course.
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