Medscape Medical News from the:
- American Academy of Ophthalmology (AAO) 2012 Annual Meeting
- Vision and other eye problems are not linked to recurring headaches in children, even if the headaches strike while the child is doing schoolwork or other visual tasks, according to a study presented at the American Academy of Ophthalmology (AAO) and Asia-Pacific Academy of Ophthalmology 2012 Joint Meeting.The investigators conducted a retrospective review of 158 children 18 years old and younger who presented to a pediatric ophthalmology practice complaining of headaches between 2002 and 2011."Our idea was to compare children for whom glasses were indicated to those who did not need glasses, and see if the headaches got better [with corrected vision]…. Ultimately, those 2 groups had the same outcomes. Whether or not the child had a refractive error that warranted correction, the presence or absence of headache remained the same. From this, we concluded that refractive error is not playing a large role in pediatric headaches," said Zachary Roth, MD, from the Albany Medical Center, New York, who presented the findings."This information should be passed along to paediatricians," he added.All of the children had received complete eye exams by the clinic's ophthalmologists, and the results were compared with their previous medical records (eye exams and other medical care).No significant correlation was found between the presence of headache and the need for vision correction. For just over 75% of the children, eye health and vision test results remained normal or unchanged from earlier exams, Dr. Roth reported.Children who already wore glasses were not found to require new prescriptions at the time they presented with headaches. Although 14% reported that their headaches occurred while doing visual tasks such as homework, and 90% reported visual symptoms associated with their headaches, the researchers determined that a need for vision correction was not a significant factor.Approximately 30% of the children had ophthalmologic conditions that surpassed the need for simple vision correction, including strabismus, amblyopia, and other, more serious conditions. A family history of migraine was present in 17%.Most headaches resolved over time. By parental report, 76.4% of all subjects improved, including those with refractive correction (71.9%) and those without new prescriptions (78.2%), for an insignificant difference between these 2 groups of P = .38. The study did not assess the actual cause of the headaches.Similarly, children who received new prescriptions were not more likely than others to have resolution of their headaches, Dr. Roth reported.Parents Can Be Reassured"We hope our study will help reassure parents that in most cases their children's headaches are not related to vision or eye problems, and that most headaches will clear up in time," he said.Arlene V. Drack, MD, the Ronald V. Keech, MD, Associate Professor in Ophthalmic Genetics at the University of Iowa in Iowa City, commented that the findings "mirror what we see in practice, and that is that parents assume a child with headache must need glasses."In my own practice, if a child with headache has any degree of refractive error I give him or her the glasses. Otherwise, the parents will keep bringing them back," she said. "Now, we can reference this study, showing evidence that it is very unusual that the need for glasses is the cause of headaches."Paul Joseph Rychwalski, MD, of the Cleveland Clinic, Ohio, agreed. "This study confirms what we know anecdotally. It dispels an urban myth."Dr. Roth, Dr. Drack, and Dr. Rychwalski have disclosed no relevant financial relationships.American Academy of Ophthalmology (AAO) and Asia-Pacific Academy of Ophthalmology 2012 Joint Meeting. Abstract #PO461. Presented November 12, 2012.Comment: Given the frequency of headaches in children, this is a valuable study. However given the lack of routine vision screening in India, and the high incidence of refractive errors requiring spectacles, it is still a good idea to get a vision assessment done for any child coming to us with headaches, even if they are not necessarily connected.