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Unilateral retroorbital pain with ipsilateral parietal lobe pain sudden onset 4-5 times each lasting for 15-20sec

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headache AND red flags

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NHS sudden severe headache emergency eye pain vision changes

Sudden, repeated one-sided pain behind the eye and over the parietal scalp should be assessed urgently today, particularly if this is new for you. Go to an emergency department now or call emergency services if the pain was instantly maximal, is the worst/new type of headache you have had, or keeps recurring.
Seek emergency care immediately if there is blurred/double vision or vision loss, a red eye, nausea/vomiting, weakness/numbness, facial droop, speech difficulty, confusion, fainting, fever/stiff neck, eyelid drooping, unequal pupils, or pain following injury. Sudden severe headache and eye symptoms require urgent assessment, as noted by the NHS headache emergency guidance and NHS eye-pain advice.
Attacks lasting 15-20 seconds can occur in some primary headache or facial-pain syndromes, but new sudden retro-orbital pain can also rarely signal eye, blood-vessel, or neurologic conditions that cannot be ruled out safely online. Do not assume it is migraine or stress.
Until assessed: do not drive yourself if symptoms recur or vision is affected. Note the exact onset time, number of attacks, triggers, eye redness/tearing or nasal blockage, and any neurological or visual symptoms, and tell the clinician.

Possible causes

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unilateral short duration headache

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unilateral eye headache short attacks causes SUNCT trigeminal neuralgia acute angle closure reputable source

Possible causes include:
  1. SUNCT/SUNA headache syndrome
    Short, severe, strictly one-sided pain around the eye lasting seconds to minutes. It is more likely if the same-side eye becomes red or watery, the eyelid swells/droops, the nose runs or blocks, or there is facial sweating. Your 15-20 second attacks fit the duration range. These are uncommon and need clinician assessment, often with brain imaging for a first presentation. A recent clinical overview of SUNCT/SUNA describes attacks as typically periorbital and lasting 5-250 seconds.
  2. Trigeminal neuralgia, especially the ophthalmic branch
    Usually sudden electric-shock, stabbing, one-sided facial or eye/forehead pain lasting seconds. It may be triggered by touching the face, brushing teeth, chewing, talking, cold air, or washing. Pain is more often facial than parietal.
  3. Primary stabbing headache ("ice-pick headache")
    Brief, sharp, unexpected jabs that can occur in the orbit or anywhere in the head. This is possible, but it is a diagnosis made only after concerning eye and neurologic causes are excluded. Harrison's describes this as pain lasting from 1 to many seconds.
  4. Other trigeminal autonomic headaches
    Paroxysmal hemicrania and cluster headache also give one-sided eye pain, but their attacks are usually longer: typically minutes for paroxysmal hemicrania and 15 minutes to hours for cluster headache. They commonly cause tearing, red eye, blocked/runny nose, or restlessness.
  5. Eye conditions needing prompt exclusion
    Acute glaucoma, uveitis, and optic-nerve inflammation can cause retro-orbital pain. They are more likely with a red eye, blurred vision, halos around lights, reduced vision, light sensitivity, nausea, or vomiting. Urgent eye-pain guidance recommends emergency assessment for sudden eye symptoms with severe pain or visual loss.
  6. Blood-vessel or brain causes that must not be missed
    Less commonly, carotid artery dissection, subarachnoid bleeding, reversible cerebral vasoconstriction, or other intracranial pathology can cause sudden unilateral orbital/head pain. Carotid dissection can be associated with a drooping eyelid and smaller pupil on that side, neck pain, pulsating sound in the ear, or later stroke-like symptoms.
Because this is new, sudden-onset, recurrent retro-orbital pain, please seek same-day urgent in-person evaluation, even if it has stopped. Go to emergency care immediately for sudden maximal "worst-ever" headache, any visual symptom/red eye, vomiting, neck pain, eyelid droop or unequal pupils, weakness/numbness, speech problems, confusion, fainting, fever, or stiff neck.
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