Optometrists play an important role in evaluating children who present with headaches. A comprehensive assessment is required to rule out neurologic signs, ocular pathology and binocular vision or accommodative dysfunction. Communicating findings to the patient’s medical doctor is also key.
A common reason that children are referred for an eye exam is a complaint of headaches. In fact, a survey found that 17 percent of 4- to 18-year-olds reported frequent, severe headaches and/or migraine in the previous year.1 Specifically, the prevalence of headaches was 4 percent of 4- to 5-year-olds and increased to 25 percent of 12- to 18-year-olds.
Often, pediatricians are tasked with determining if headaches are primary (tension, migraine) or secondary (organic, vascular, infectious, ocular, etc.). Before referring to pediatric neurology, rule out common causes of secondary headaches. This is where optometry comes in: ODs have a great opportunity to show colleagues their knowledge.
Related: The effect of contoured prism lenses on chronic headaches: a case study
A comprehensive history is one of the most important components of headache evaluation. Discovering the temporal pattern of the headache is essential. These patterns can be divided into five categories in children: acute, acute-recurrent, chronic-progressive, chronic-nonprogressive, and mixed (Figure 1).2
Of these temporal patterns, chronic-progressive is the most ominous and should alert the examiner to be suspicious of organic causes (such as neoplasia, altered intracranial pressure, hemorrhage). Chronic-nonprogressive and mixed headache patterns are more likely to have ocular causes (such as uncorrected refractive error, binocular vision or accommodative dysfunctions).
Other factors to consider strongly as role players in pediatric headache are social stressors. These can include school, social media, friends, and drugs/alcohol. In addition, this can be compounded by lack of sleep or irregular sleep schedules, diet/nutrition, and dehydration. Be sure to include these components in the headache history.
1. Lateef TM, Merikangas KR, He J, et al. Headache in a national sample of American children: prevalence and comorbidity. J Child Neurol. 2009 May;24(5):536-43.
2. Blume HK. Childhood headache: a brief review. Pediatr Ann. 2017 Apr 1;46(4):e155-e165.
3. Scheiman M, Wick B. Clinical Management of Binocular Vision: Heterophoric, Accommodative, and Eye Movement Disorders. Philadelphia: Lippincott Williams & Wilkins, 2013.
4. Convergence Insufficiency Treatment Trial Study Group. Randomized clinical trial of treatments for symptomatic convergence insufficiency in children. Arch Ophthalmol. 2008;126(10):1336-1349.
5. Scheiman M, Cotter S, Kulp MT, et al. Treatment of Accommodative Dysfunction in Children: Results from a Randomized Clinical Trial. Optom Vis Sci. 2011;88:1343–52.
6. Lewis DW, et al. Practice parameter: Evaluation of children and adolescents with recurrent headaches: Report of the Quality Standards Subcommittee of the American Academy of Neurology and the Practice Committee of the Child Neurology Society. Neurology. 2002 Aug 27;59(4):490-8.
7. Sheridan DC, Waites B, Lezak B, et al. Clinical factors associated with pediatric brain neoplasms versus primary headache: a case-control analysis. Pediatr Emer Care. 2017 Nov 14. doi: 10.1097/PEC.0000000000001347.