Characteristics of Headache in Children Presenting to Ophthalmology Services in a Tertiary Care Center of South India

Introduction: Headache is a common cause of disability worldwide and can disrupt the education and social life of children. Children regularly present to ophthalmologists with headache. So, we aimed to describe the characteristics of headache in children presenting to the ophthalmology outpatient department (OPD) in our center. Methodology: We conducted this cross-sectional, prospective study in Bangalore, India. We included all children aged 5-18 years, presenting with headache to the ophthalmology OPD, from September 2018 to September 2020, and excluded nonverbal children, those with prior head trauma, diagnosed psychiatric illnesses, or epilepsy. We provided each child with a headache questionnaire, following which they received a detailed ophthalmologic evaluation. We performed relevant descriptive and inferential analyses. Results: We included 311 children, with a mean age of 11.1 years. Sixty-eight percent were males. Fifty-one percent reported holocranial headache, and 28% reported frontal headache. Sixty-nine percent reported screen time of ≥2 hours/day. The most common refractive error (RE) was myopia, seen in 48%. The most common type of headache was headache associated with refractive errors (HARE), seen in 64%, followed by migraine, in 19%. Children with HARE were more likely to be males, have daily screen time of >2 hours/day, or have myopia. Their headache was more likely to be for >1 month, or have frontal localization. Children with headache due to other causes were more likely to be adolescents. Discussion: We found that almost two-thirds of children presenting to our ophthalmology OPD had HARE. Our findings support the association of REs with headache. Children with HARE had a longer history and predominantly frontal localization. Further, they reported longer screen time, a significant finding in today’s world. Ophthalmologists must be aware of the various etiologies of headache and ensure that each child with headache receives a full ophthalmologic evaluation.