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Headaches in children are common.  Fortunately, it is often not serious. They can occur in 3 out of 4 school-aged children.  Just as adults, there can be a number of causes.  The most common causes of headaches in childhood include:

  • Stress-related or tension headaches

  • Migraines

  • As a symptom of viral or respiratory infection

  • As a result of minor head injury

Only a small minority have a serious cause, such as brain tumor or life-threatening infection.

How should children with headaches be evaluated?

Children should first be evaluated by a pediatrician.  Often, the cause of the child’s headache can be determined by a complete medical history and physical exam.  A detailed headache diary may also be helpful in finding the diagnosis.  Imaging studies are usually not necessary.

If no obvious medical cause is found, a child may be referred to a pediatric ophthalmologist for a complete eye exam.  During this exam, the entire visual system will be evaluated.  This include the pupils, any refractive error (need for glasses), eye alignment, and binocularity (the ability to use both eyes together).  The pupils will also be dilated so that the optic nerves and retina can be properly examined and the refractive error can be most accurately assessed.

Can headaches be associated with eye or vision changes?

Some children with migraines may experience changes in their vision before the onset of the headache.  This is referred to as an aura.  The aura may include flashing lights or bright spots, zigzag lines, or partial loss of vision.


Tension headaches may be associated with pain in the head, neck, and behind the eyes.  Sinus disease may cause pain or pressure over the forehead, nose, or eyes.  Cluster headaches, which is uncommon, may be associated with eye redness or tearing on the side where the pain occurs.

Can eye problems cause headaches?

Research has shown that vision and eye problems are very unlikely to be the cause of recurring headaches in children, even if the headaches occur while the child is doing schoolwork or other visual tasks.  That said, a complete eye exam will rule out certain conditions that can be treated to reduce eye strain and fatigue.


Certain refractive errors (such as hyperopia or farsightedness) may require extra effort to focus clearly when reading.  This can lead to feelings of eye strain, fatigue and headache.   To a certain degree, farsightedness is normal in children, but very farsighted kids when require glasses.


Another problem may be issues of convergence or what is called convergence insufficiency.  When we read or perform near activities, our eyes naturally pull towards each other, this is called convergence.  When one or both eyes have trouble converging, this can lead to doubling of images or words, blurred vision, eye strain, and headaches.  This condition can be helped with eye exercises at home, or with the aid of a computer program.  If glasses are helpful, they may also be prescribed.


Certain medical conditions of the eyes may have headache as a symptom.  These acute infectious and inflammatory conditions are often accompanied by redness of the eye and/or eyelid, as well as light sensitivity.  Acute glaucoma can cause headaches, but this condition rarely affects children.  Intraocular pressure and signs of glaucoma can be evaluated during a complete eye exam.


If no ocular causes of headache are identified, the child may be referred back to his/her pediatrician and/or a neurologist to look for other possible causes of the headaches.

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