"The groundwork of all happiness is health." - Leigh Hunt

Headaches in children may be attributable to eye problems

July 10, 2023 – Eileen Brewer is the mother of an 11-year-old who often suffers from severe headaches.

“She showed signs of headaches as a baby,” said Brewer from Columbia, Maryland, where she is president of Clusterbusters, a company that supports research into treating cluster headaches and advocates for people affected by the condition.

Brewer's daughter often cried for as much as 8-10 hours a day. A pediatrician said she had colic. But as she got a little bit older, she began banging her head on the ground or hitting her head along with her hands. The pediatrician said it was all behavioral.

But when she was in preschool, the teacher told Brewer that her daughter would complain of headaches on sunny days after playing outside. “She would lie down in the book corner,” Brewer said. The teacher suspected that the little girl might need a migraine.

“I was surprised and a little embarrassed that I had missed the signs, including frequent vomiting,” Brewer said. “I have migraines myself, and they're genetic. And I work in the headache field, not only at Clusterbusters, but also as the administrative director for the Alliance for Headache Disorders. And I'm a member of the Patient Leadership Council of the National Headache Foundation.”

The pediatrician referred Brewer to several specialists, including an otolaryngologist, a pediatric ophthalmologist, a dentist and a pediatric neurologist. Her child had no problems along with her ears, sinuses or teeth, however the ophthalmologist found a blocked tear duct and problems along with her vision.

“That is, when my daughter reached the end of a line of reading, she had a hard time finding the next line because her eyes moved differently than most people,” Brewer said.

Although she received physical therapy for her eyes, Brewer's daughter continued to suffer from headaches. The neurologist diagnosed her with chronic migraines. Now she takes Propranolola drug sometimes used to forestall migraine attacks, and Sumatriptana medicine used when a migraine attack has already began.

“Window to the brain”

About 60% of kids and adolescents suffer from headaches, in keeping with a study conducted by the authors of a new study published within the Journal Ophthalmic epidemiologyThese headaches can affect a baby's quality of life, limit their ability to operate, and impact school attendance and performance.

The authors of the brand new study desired to learn how common eye problems are in children with headaches. They studied children who visited a watch doctor with headaches, said lead study creator Lisa Lin, MD, a graduate of the ophthalmology residency program at Massachusetts Eye and Ear in Boston. The study was conducted at Children's Hospital of Philadelphia, where Lin studied medicine.

Lin and her colleagues reviewed the medical records of 1,878 children between the ages of two and 18 who presented with headache symptoms at an outpatient eye clinic.

All children underwent a watch examination to find out whether or not they had any eye problems or other conditions that may contribute to the headaches.

The researchers found that a couple of quarter of the youngsters had a number of recent eye-related findings that will have contributed to their headaches.

Almost a fifth of the youngsters had Refractive problems of the attentioncorresponding to nearsightedness, farsightedness or astigmatism.

The second commonest eye disease, present in 4.4% of kids, was Strabismus (eye misalignment). Very few children had other conditions that might cause eye pain or be an indication of an intracranial problem, including Uveitis, glaucomaand optic nerve elevation.

Patients with eye problems tended to experience shorter-lasting headaches, but there was no association between eye problems and the frequency of headaches, photosensitivity, nausea/vomiting, and visual disturbances.

Lin acknowledges that the study was “limited” since the researchers didn’t monitor the youngsters to see if their headaches improved when the attention problem was corrected, for instance by wearing glasses.

However, the findings are necessary because about “a quarter of the children had a treatable eye condition. The eyes are often a 'window to the brain' and may need to be examined if children complain of headaches,” she said.

Take headaches in children seriously

Paul G. Mathew, MD, assistant professor of neurology at Harvard Medical School, said he was not surprised by the outcomes.

“Most of the children with eye problems in the study had problems with poor vision and probably needed glasses,” he said.

He said that the usual tests utilized by doctors cannot detect all eye problems and that sometimes a more thorough eye examination is needed.

“I think it makes sense for a child to see an ophthalmologist when they have headaches and visual problems. However, I would also caution against sending every single child with a headache to the ophthalmologist, as this would increase the cost of treatment and delay the evaluation and treatment of children with more urgent ophthalmological problems,” said Mathew.

Eye problems may cause headaches, but may also worsen headaches in individuals with conditions corresponding to migraines. He warned that a baby complaining of a headache shouldn’t be ignored or dismissed.

“I've noticed that parents often don't take headaches in children seriously enough, especially when they're rare or episodic,” said Mathew, a board member of the National Headache Foundation. “All too often, children are told, 'You're just exaggerating' or 'You're exaggerating.'”

Mathew, whose 11-year-old daughter suffers from headaches, said there’s increasing awareness of migraines in children. “In the past, children with migraines were given treatments that were inconclusive at best, but now more treatments are available and migraines in children are starting to be taken more seriously.”

He is comfortable about this because “if children cannot go to school, play sports or do other activities because of their headaches, it is detrimental to their development.”

Advice for fogeys

If your child is affected by headaches, Mathew recommends first seeing a pediatrician who can resolve whether the kid needs further consultation with a specialist corresponding to an ophthalmologist or neurologist.

“Take nausea and vomiting seriously,” he said. “Children often have comprehensive gastrointestinal evaluations, but these stomach problems can be symptoms of a migraine.”

Although the episodes should not quite common, Mathew says they shouldn’t be taken calmly as they will turn out to be more frequent and severe after puberty, especially in girls.

If your pediatrician isn't taking the issue seriously, Brewer advises getting a second opinion. “You know your child better than anyone else. Even if you're a new parent, trust your gut and push for the best diagnostic measures,” she said. “Advocate for your child and don't give up until you find someone who takes the symptoms seriously and has a good answer for you.”

Mathew also recommends listening to headache triggers corresponding to lack of sleep, stress, dehydration, late meals and changes within the weather. “Right now, my daughter's headaches are still rare and fairly predictable,” he said. “They tend to happen after flights or when she is severely sleep deprived. So when we go on vacation, we plan plenty of rest periods to make sure she gets enough rest.”

This is a vital message for today's parents, lots of whom have children under loads of pressure from the mixture of schoolwork and extracurricular activities. “Make sure your child gets enough rest, eats regular nutritious meals, stays hydrated and gets enough sleep, and be aware of what might be triggering their seizures,” Mathew said.