Headache in the paediatric population: the role of the ophthalmologist

Introduction: Headache is a very common pathology in pediatric age, but the responsibility of ophthalmological factors in determining headache may be underestimated. Aim: Identify how headache presents and determine the prevalence of the different causes in children; investigate the role of the ophthalmologist and of the ophthalmic diagnostic investigations in the diagnosis and treatment of pediatric headache. Methods: 101 children, aged 4–18 years, with non-traumatic headache were included in the study. Each child underwent a questionnaire regarding headache characteristics and all the clinical and instrumental examinations necessary to reach the diagnosis. Results: Migraine was the most common form (28.7%), followed by headache associated with inadequate refractive error. (HARE, 23.7%), tension-type headache (17.8%), strabismus (16.8%), intracranial hypertension (6.9%), digital eye strain (5.9%). Myopia was the most prevalent type of HARE (50%). Strabismus headache was present especially in intermittent exotropia (41.2%) and convergence insufficiency (35.3%). Discussion: HARE and strabismus, despite the latter is not included in the final version of the International Classification of Headache Disorders, can cause frontal headache in many cases. Conclusion: Ocular causes are a frequent cause of a relevant percentage of pediatric headaches.