Eye Strain Headache?

Abstract & Commentary

Synopsis: In the current study, there appeared to be no difference in headache characteristics nor was there a difference in the relative frequencies of migraine, tension-type, or other primary headache disorders.

Source: Gil-Gouveia R, et al. Headache. 2002;42:256-262.

Patients complaining of headache often claim 1 of 3 things: sinus disease; brain tumor, or simply that their eyeglasses no longer work. The International Headache Society (IHS) does recognize headaches associated with refractive errors (HARE) but notes that their importance is widely overestimated. The diagnostic criteria for HARE are as follows:

a. uncorrected refractive errors;

b. mild headaches in the frontal region and within the eyes; and

c. pain absent on awakening and aggravated by prolonged visual tasks at the distance or angle where vision is impaired.

The current observational-interview study was undertaken to compare the overall headache frequency in healthy patients with refractive errors (n = 105) compared to normal controls (n = 71). The overall headache frequency between groups was similar (45% vs 52%). There appeared to be no difference in headache characteristics nor was there a difference in the relative frequencies of migraine, tension-type, or other primary headache disorders. Of note, there was a trend suggesting that improvement in headache in the patients with refractive error was associated with correction of vision. Only 7 patients fulfilled IHS criteria for HARE and 3 of these improved with correction of vision.

Comment by Jeffrey Reich, MD

While there are methodological flaws in this small study, it is reassuring to find that, contrary to popular belief, headaches are only rarely identified in individuals with refractive errors. In patients with chronic headache, proper correction of vision should be considered as one of several factors.

Dr. Reich is Assistant Professor of Neurology, New York Presbyterian Hospital-Cornell Campus, New York, NY.