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.
Refractive, binocular vision, and accommodative problems can be managed within optometric practice. Many of these conditions can be treated or initially managed with glasses alone. Do not forget the power of lenses.
Related: Optometry on fleek: Part II
Many accommodative disorders (accommodative insufficiency, fatigue, and sometimes even spasm) can be treated with glasses as well. Giving the child a bifocal in his glasses to decrease the accommodative demand at near can make a significant difference. Additionally, high accommodative convergence/accommodation (AC/A) conditions also respond to added lenses—convergence excess with extra plus at near and divergence excess with extra minus at distance.
Binocular vision and accommodative conditions are also successfully managed with vision therapy (VT). It is the gold-standard treatment for conditions like convergence insufficiency4 and is used effectively to remediate many binocular vision, accommodative, or oculomotor deficiencies.5 Many patients who have completed a VT program will report a decrease in their symptoms, including headache. VT can be used in conjunction with lenses to manage these patients to improve their symptoms. Lenses can be used as a temporary solution to relieve symptoms immediately, while vision therapy is a longer-term solution to many of these visual conditions.
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.