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.
Sometimes it is not obvious whether the headache is due to the patient’s eyes. Perhaps the findings are borderline, and you are not convinced. In this case, a headache log can be useful to monitor headache characteristics such as frequency, duration, and what activities might trigger their onset.
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For example, headaches that occur after reading are often visual, while headaches that wake a person from sleep are not. These logs are available as free apps (such as Migraine Buddy or iHeadache) that are easily accessible and make tracking seamless.
As healthcare providers, ODs can also counsel patients on lifestyle changes that can promote a healthier and more headache-free life. Suggest these SMART lifestyle changes:2
- Sleep: Get sufficient and appropriate sleep
- Meals: Ensure regular intake of healthy foods and good fluid intake
- Activity: Engage in regular and appropriate activity, neither excessive nor deficient
- Relaxation: Consider methods of stress management and relaxation
- Trigger avoidance: Recognize and avoid or manage situations that provoke headache
ODs are part of the team working toward getting to the root of the headache. Your findings will prove useful to the patient’s medical doctor. While it may help cross a differential off the list, it also could be the information the provider was waiting for to show medical necessity for neuroimaging.
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.