Headaches come from many different sources and people often bring their child to see the eye doctor first to rule out vision problems as a cause. Usually it is not a vision related problem, but there are cases that have a direct correlation with the eyes. If headaches are related to eye problems, most of the time there will be a specific visual task the headaches seem to center around. It could be reading, computer use, video games or time in the sun.
Eyeglass frames can cause pressure behind the ears and on the side of the head if not properly adjusted. Frames that are tilted can alter the effective lens prescription and result in eye strain. Nickel is a common component in many metal frames (and in parts of plastic frames). Nickel allergies are fairly common and can cause discomfort, itching and possible mild headaches.
Your child’s prescription may cause headaches under certain conditions. Large uncorrected amounts of farsightedness are probably the most common cause in children. With farsightedness, they may have the focusing capacity to pass the eye chart test with flying colors while not wearing prescription lenses. In doing so, they may be close to using all of their focusing reserve capacity. This would be like spending all day walking around carrying close to the maximum amount of weight you can hold. Because the focusing muscle is considered smooth muscle and does not fatigue like the striated muscles you use for your arms or legs, there is some disagreement on this point. It is really an academic point since the headaches do commonly occur, possibly due to variations in focusing and resultant clarity, constriction of the colored iris tissue, or other unknown factors. How much uncorrected farsightedness is required to cause headaches? We know higher amounts are more significant as age increases but with lower amounts it is not as clear what levels create eyestrain and headaches. Sometimes the only way to know is to fill an eyeglasses prescription and see if the headaches resolve.
Focusing problems in general are very hard to diagnose with precision. Eyes may over focus, under focus, have variable focusing, and on rare occasions have focusing spasms. Some prescription medications can cause focusing problems, dry eyes and sensitivity to light increasing the likelihood of headaches.
Uncorrected nearsightedness can cause a child to squint to see the blackboard and result in headaches. Usually they will be complaining about blurry vision, unlike with farsightedness. Nearsightedness has normally been corrected due to blurry vision before there are complaints about headaches.
Astigmatism is a condition where the eye has two different curvatures, shaped more like half of a tennis ball squeezed on top and bottom. While astigmatism does blur vision, children frequently notice more eyestrain than blurriness. The eye is focusing for one curve then the other trying to find the clearest focus point. Moderate to high levels of astigmatism can cause headaches but usually the child has complaints that sound more like eyestrain and may be squinting to try and clear things up.
Convergence insufficiency is one of the leading causes of headaches related to vision in children. When your child reads or works up close the eyes have to perform two functions. First they have to adjust the focus for the correct distance. Secondly they must turn in both eyes (converge) to point in the exact direction of what they are looking at. Most reading is done at about 14 to 16 inches away from the face in children. Kids should be able to keep their eyes pointing at an object at least until it is within 4 to 6 inches from their nose. If they can’t, they lack enough reserve capacity to keep their eyes pointed at the object and they will have eyestrain and headaches. The severity of the problem is related to how well their brain functions in partially shutting down the image from one eye. If they lack this capacity the headaches can be severe with near work, resulting in headaches, eyestrain, blurred vision, and failing grades in school.
Muscle imbalances are similar to convergence insufficiency. Due to eye muscles or tendons that are slightly misshaped or inserted slightly abnormally, their eyes may have a tendency to turn in, out, up, or down. Constantly struggling to keep images from doubling can cause frequent headaches if the brain is not good at shutting off one of the images. Fixation disparities are very tiny eye alignment errors that can have a similar result but can only be diagnosed with appropriate testing.
Migraines are a very common cause of headaches and take many different forms. Usually there is a family history of migraines already known. Children that develop migraines at an older age often are carsick at younger ages. These headaches tend to be on one side of the head and may be associated with nausea and light sensitivity. Migraines need to be thoroughly tested and diagnosed in conjunction with your child’s pediatrician and possibly a neurologist. The only association migraines have with eyes are some people have migraines triggered by small changes in their eye glass prescription, and some migraines can cause very minor damage to the eyes over time.
Some children and adults are naturally very sensitive to small changes in their eyeglass or contact lens prescription. Every time there is a minor change they start having headaches, and learn quickly it is time for an appointment with the optometrist. Autistic children may have somewhat of an opposite type of problem, and clearing up vision too much may contribute to sensory overload and headaches.
Rare causes of headaches around the eyes are tumors around the optic nerve or eye. Inflammation inside the eye that sometimes accompanies childhood arthritis and other autoimmune diseases can cause eye pain, headaches, and light sensitivity. Unusual light sensitivity, red eyes, headaches, abnormally small or large pupils, changes in behavior and school grades can be indicators of illicit drug usage, now common even in elementary schools. School counselors usually have a pretty good idea who is involved and it is a quick call.
A sinus infection can result in headaches around the eyes and in rare cases even sight loss.
Never forget lack of sleep. Fatigue, poor diet, caffeine crashes, dehydration, and stress probably cause most headaches. Preventative eye exams for children always helps rule out some easily fixed causes so don’t neglect an eye check up if your child is being afflicted with headaches.
Last, but not least is the friend who just got new glasses syndrome. All of a sudden your child develops blurry vision and headaches. Fortunately, an optometrist can diagnose this case pretty easy. Sometimes you may want to consider discussing in advance with your child’s eye doctor a placebo pair of glasses with little or no prescription. Occasionally with a strong willed child it is easier to just let them wear a pair for six months and spend your energy on the bigger battles.
Ten Reasons To Be More Concerned About Your Child’s Headaches
1. Headaches that are continuing to get worse or becoming more frequent
2. Headaches that occur in the same area of the eye or head
3. Headaches that wake children up at night or are present at the beginning of the day
4. Headaches accompanied by double vision, blurred vision, or abnormal eye movements
5. Headaches that cause a child to cease their normal activities
6. Any headache that occurs after a fall, possible bump to the head, or after loss of consciousness or memory, however brief
7. Any headache that is accompanied by changes in responsiveness, sluggish thinking, slurred speech, changes in balance, different pupil sizes, severe vomiting, droopy half open eyes, altered or unusual behavior
8. Headaches that only occur when a specific person is around (possible abuse)
9. Headaches occurring in other people present (possible carbon monoxide poisoning)
10. Severe Headaches with very rapid onset, high fever, stiff neck
If you have concerns about your child having mild or moderate headaches, starting with appointments with your optometrist and family doctor makes sense, proceeding to a neurological evaluation if needed.
