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November 12th, 2012
09:02 AM ET
Children's headaches rarely linked to vision problemsIf your child gets recurring headaches and you think they might need glasses, you may be mistaken - a new study says children's headaches are rarely triggered by vision problems. The study, presented Monday at the American Academy of Ophthalmology's annual meeting, was conducted by researchers at the ophthalmology clinic of Albany Medical Center in New York. They evaluated medical records of nearly 160 children under the age of 18 who were being seen at the clinic for frequent headaches. Researchers compared the exams of children with headaches to their earlier vision exams and other medical records. In 75% of the children, the vision test results were the same. No significant link was found between the headaches and a need for glasses - even if the headaches happened when the child is doing a visual task like homework. "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," said Dr. Zachary Roth, who led the research team. "The information should also be useful to family doctors and pediatricians in caring for children and parents who have this common health concern." Researchers found in most cases, the children's headaches resolved over a period of time regardless of whether the child got a new prescription for glasses or not. And those who did get new glasses were no more likely to have their headaches get better. It's highly unusual to find something wrong with the eyes when a child complains of headaches, says Dr. Daniel Neely, a professor of ophthalmology at Indiana University who specializes in pediatrics and the chairman of the American Association for Pediatric Ophthalmology and Strabismus' vision screening committee. "The study is consistent with everyone's clinical practice around the country. If the child has headaches the first stop should be their primary care doctor, and they will assess whether or not a comprehensive eye exam would be indicated." According to Neely, vision screenings - whether someone just measures the vision with an eye chart or with a vision screening device (camera-type devices called photo screeners) - should be part of a pediatric well-child visit . "Some of them are very good about doing it and some of them are not very good about doing it, but the recommendation is that it should be done every year or two," he says. " ... What we don't recommend is that everyone get a comprehensive eye doctor eye exam unless they fail a screening or unless there is something in their family history that puts them at increased risk." Neely says if vision screening is not being offered as part of the well-child visits, ask for it - sooner rather than later. "The reason that there's a time factor on these screenings is because of a condition called amblyopia," he says. "Young children less than age 7 are neurologically immature and if you have something significant affecting their vision, their brain will actually stop using the eye or both eyes and that becomes permanent loss of vision if not detected and treated. So the younger you identify them, the more easily you can treat them." Amblyopia, or lazy eye, is very common in children and is responsible for more vision loss than all the other causes combined, according to AAPOS. It happens when the eye sends blurry images to the brain, confusing it and causing the brain to learn to ignore images from the weak eye. And Neely says as children get older they are less likely to respond to corrective treatment. "So if you detect something at age 10 that was serious, it would be too late. And that, again, is why we want the pediatrician doing this, because by the time the kid gets to school that window of opportunity is closing. So a vision screening by the school nurse in first grade might be too late." Most pediatricians will do some variation of the screening at every visit, Neely says, but AAPOS recommends children have a documented vision measurement by age 5.
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Get a behind-the-scenes look at the latest stories from CNN Chief Medical Correspondent, Dr. Sanjay Gupta, Senior Medical Correspondent Elizabeth Cohen and the CNN Medical Unit producers. They'll share news and views on health and medical trends - info that will help you take better care of yourself and the people you love. Recent Comments
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I beg to differ with the results of this study, although I can not at present get hold of the whole paper. In my experience as an Optometrist working largely with children, a large proportion of children who complain of headaches, sometimes but not always associated with eyestrain, do require some optical help or exercise.
These children most commonly complain of headaches during the school day, or after prolonged close work at home. They are often on computers in their spare time too, so hours a day are dedicated to concentrating close up.
IF the child has weak focussing skills or poor convergence then those prolonged hours can easily cause discomfort in frontal or temporal areas of the head. Parents may notice far fewer complaints of headache in holiday times when less concentrated close work occurs.
Children may need appropriate optical correction in classrooms or when reading, possibly along with exercises to improve their ability to converge more easily near to, or change focus with more flexibility if that's the issue. So don't neglect the one test your child can't fail; their eye-test!
If the patients in the study had all been complaining of headaches previously and these findings were based on re-tests then one wonders what had been done to help them and why, if vision was not involved, they were being followed up in an ophthalmology clinic!
This fact is known for years and has been mentioned Nelson's Pediatric text book in multiple editions. Large number of children have their first vision check during headaches and are diagnosed to have refraction problems coincidently. However due to American Academy of Pediatrics recommendation to check vision as early as 3 years incidence of association between headaches and vision problem has been diminished. That is what I as practicing Pediatrician have noticed.
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It is very important that doctors may use advanced tools to make the right diagnosis. For instance headaches can be linked to hundreds of different diseases. Actually, doctors use smart reminder solutions like ESAGIL or ISABELLE that link symptoms and signs with diseases.
Not suprising that ophthalmology still ignores binocular vision
Well said!!! I agree whole-heartedly as a fellow optometrists who have seen pediatricians and ophthalmologist mis-diagnose and/or ignore hyperopia.
In general, the study is flawed.
Great article and medical research study about children's vision! A nice reminder about the need for vision screenings also.
Vision screenings at school or the pediatrician's office have been shown to miss 30% of significant vision problems that can negatively impact the ability of a child to learn. In Illinois a law was passed requiring an eye exam by an eye doctor for every student entering k-12 for the first time in the state. The bill for this law was NOT initiated by eye doctors: it was started by the Illinois state teachers association because they were frustrated with kids not being able to see who had PASSED the previously required vision screenings. No, Ophthalmology, screenings are not enough.
I agree with the above opinions – this study seems very misleading. Usually pediatrician vision screenings only test the ability to see far vision with no attention to near visual skills. 20/20 vision at distance (with or without glasses) does not mean comfortable vision when performing prolonged near tasks so wearing glasses for improved far vision would not necessarily improve headaches. Comprehensive eye exams do allow for examination of all visual skills.
And stating age cut-offs for visual improvement is inaccurate and can hinder parents in receiving proper care for their children. While improvements are easier to accomplish at younger ages, vision and depth perception can be improved in all ages including adults as noted in these studies:
http://www.ncbi.nlm.nih.gov/pubmed/14769219
http://www.ncbi.nlm.nih.gov/pubmed/15013894
http://www.hopkinsmedicine.org/Press_releases/2005/04_11b_05.html
Just because most headaches in children are not related to eye problems does not mean that children with eye problems do not get headaches. Vison screenings give parents a false sense of security. Most vision screenings are primitive and our children deserve better. http://www.gheye.com/do-vision-screenings-fail-our-children/
This is an example of how personal opinion can be made to sound like a "scientific" study. If the appropriate tests aren't done, a vision problem that truly exists will not be found. I see patients almost everyday who have seen multiple doctors for headaches that can be solved easily after properly identifying a vision problem. Many ophthalmologists believe that it is not necessary to correct farsightedness in children unless it causes strabismus (eye turn) so they are not going to consider it to be a visual problem in spite of the fact that it frequently causes headaches when people are doing nearpoint visual tasks. Many of those same doctors falsely believe that children cannot have deficiencies in the nearpoint focusing mechanism so they don't even test for those problems. It is simply not true that children do not have these problems but if not doing the test, the problem is not found and the parents are told there are no vision problems. Eye coordination problems that cause headaches are also often missed during eye examinations. If you or your child frequently develops headaches while doing visual tasks, it is most often going to be a problem with the visual system. To assume otherwise is illogical. If your eye doctor doesn't solve the problem, please seek another opinion.
STRONGLY DISAGREE, For over 100 years eyecare professionals have known that headaches in children and adults that primarily occur when reading are OFTEN due to visual problems and most commonly, simply being farsighted can cause these headaches!! One study of 160 patients, done at a referral center, can in no way be used to throw out this truth. Telling parents that most headaches in children are not vision related is absurd and could prove costly in more ways than one. LOOK at the population of the "test subjects". They are children with frequent headaches at a large Ophthalmology clinic in New York. A clinic that likely receives many referrals of "difficult" cases. Of-course, for some of the patients, this clinic may have been their first or primary eye exam. But I am sure that many, if not most, came to them because glasses had already been tried and proved ineffective or not fully effective in curing the headaches. This would automatically taint the population toward non-vision related causes.
Back to how this could prove costly. It is suggested that a visit to their Primary Care Physician(PCP) should be the first step. I would say that the cost of a visit to your PCP, and any extra tests that may need run, would cost you or your insurance company substantially more than a visit to your local Optometrist. If that visit finds a visual cause for the headaches, then you will have saved a huge step and huge cost. If that visit finds no visual problem to explain the headaches, then a visit to your PCP would be advised.
In my practice, I find the opposite of this "study" to be true and OVER 75% of patients complaining of headaches after or during reading find relief with new glasses or with vision training exercises. Telling the public and PCP's that these headaches are usually not vision related, may very well prevent the parents and or the PCP's from seeking out a thorough eye exam at the earliest age. This, as Dr Neely did point out, is the most important factor in being able to correct amblyopia and or strabismus...... Catch it early!!! This article may do great damage to that effort if very many people read it and believe it!
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I think it depends on the type of headache. When children are small it's difficult for them to accurately describe what they are feeling sometimes so it's always best to have a pediatric eye exam performed to identify the problem.
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Regrettably, the public and health care professionals and news agencies (like CNN) who read the press release by the AAO were seriously mislead. The purported study did not follow scientific standards held to any other valid research and was not published in a peer reviewed journal. Rather this was a poster project of an ophthalmological resident and put on display at the AAO Annual Meeting. While one would think that a news agency would vet their stories, I don't blame them given they were simply passing on the information supplied by the American Academy of Ophthalmology. What is truly questionable is why the AAO would promote research about children's vision, so poorly constructed as fact? Which raises the next question, who is really looking out for children? For a more in depth analysis here is a link to the VisionHelp Blog: http://visionhelp.wordpress.com/2012/11/15/giving-the-public-a-headache-part-2-murky-evidence/
bells palsey? I was in 5th or 6th grade (I am now 69). Severe headaces behind ear. I remember on my knees and crying into my mothers lap. They got me glasses. It finally went away. In the last 25 years I have bells palsey 3 more times. Also have gotten 3rd nerve palsey twice. My current physical therapist has treated a child age 9 or 10.
As an ophthalmologist, I see way too many children come into my office after seeing their OD and spending hundreds of dollars on "reading glasses" that contain almost no prescription, glasses that they don't need and look over the entire time, or costly vision therapy that the medical literature does not support (and American Academy of Pediatrics says is a waste of patients' time and money). ODs need to stop touting non-vision related problems as eye-related. I'd like to know how many children walk out of an optometrists office without glasses? Very few...all these kids do not have a vision problems!
Very true. Here's a research study about over prescription of glasses by ODs: http://www.ncbi.nlm.nih.gov/pubmed/15226721?dopt=Abstract.
DITTO with ophthalmologists prescribing steroids for every red eye which walks into their office.
DITTO with ophthalmologists telling every cataract patient to return in 6 months just to collect more money from Medicare.
DITTO with ophthalmologists telling patients who have untreatable macular degeneration to return every 3 months and never having the courage to give them a true prognosis.
Hi everybody, The discussion is really long and interesting. Each persons view is valid. Nevertheless, in view of a child suffering from headaches first thing to be checked is vision; now that could be myopia or any other visual defect: This fact can not be disregarded and parents should not be advised to wait and watch for headaches to disappear on their own.
Usually parents have already waited for a reasonable time before they contact their Doc.
Headaches have many causes like abdominal pain and certainly need to be investigate with due sincerity. Usually stress headaches and sinus headaches (in older children) disappear on their own; but even if these are persistent they demand medical attention.
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Lazy eye is not for life even if found at age 10 or later! New studies are showing that even adults can have significant improvement if playing video games while wearing an eye patch over the normal eye. My child is ten and we just had to have her glasses adjusted since she went from 20/50 to about 20/20 while wearing her glasses and patching about four days a week. An eye patch, the right glasses and a hand held video game can be the right combination for older children and adults with even significant lazy eye! Just twenty minutes patching/gaming a day has been shown to improve vision by over 50% in adults.
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