A 46-year-old female patient with severe headache, nausea and vomiting was treated at a local health center for 3 days, but her symptoms did not improve, so she was referred to our hospital. The emergency cranial CT did not show any significant abnormality. She was admitted with “headache to be investigated: migraine”. The patient complained of severe headache, nausea and vomiting 2~3 times/day since 3 days ago, without dizziness, visual rotation and tinnitus. No syncope or paralysis. Previous physical fitness. Blood pressure: 134/79 mmHg. clear consciousness, answers to questions. Bilateral pupils are equally round and large, ¢3.0mm, light reflex is present. Neck is soft, no resistance. Muscle strength and muscle tone of the extremities were normal. Pathological signs were not elicited. The analysis concluded that simple migraine usually does not present with severe headache that is difficult to control with conventional analgesics; the patient’s blood pressure was normal and hypertensive encephalopathy could be excluded; there were no positive findings on neurological examination and CT excluded intracranial abnormalities. Follow-up history revealed that the patient thought that the eye pain was caused by the headache because of the severe headache, although the eye pain and blurred vision, so he only said the former and ignored the latter. I urgently requested an ophthalmology consultation. Ophthalmologic physical examination revealed ciliary congestion of the conjunctiva in both eyes, corneal edema, and shallow anterior chamber. The pressure in the left and right eyes was measured as 95 mmHg and 109 mmHg (normal IOP: 50-80 mmHg), respectively. The visual acuity of both eyes was 0.8. Consultation result: acute angle-closure glaucoma. After 1 week of comprehensive treatment including emergency IOP lowering and compound trabeculectomy + iris rhizotomy, the patient’s headache and eye pain disappeared and the visual acuity returned to normal. The patient’s first visit to the internal medicine department is often due to the severe headache, nausea and vomiting as the first symptoms during the acute closed-angle glaucoma major attack. These symptoms mask the eye pain and vision loss, and internists focus more on internal system diseases and easily overlook diseases outside the internal system (e.g., ophthalmic diseases).