Correspondence (letter to the editor): Considering the Eyes

In my ophthalmology practice with focus on strabology and binocular vision disorders, headache is one of the most commonly reported complaints, besides specific reading disorder/dyslexia and AD(H)D, but often it takes a targeted question to learn about it. It is so common for school children to experience headaches that they do not consider it necessary to mention them. Headaches always go along with uncorrected impairments of binocular vision in the sense of associated heterophoria.

Vision, and binocular vision in particular, is an extremely complex process, comparable with two linked autofocus cameras which have to send every second the enormous amount of 10 MB of data—in conjunction, simultaneously and for both sides identically—generated by the complex retinas to the brain, including the motor centers in the diencephalon, the nuclei that govern eye movements, the vestibular system, the cerebellum, and the autonomous nervous system. In addition, they have to react to the responses of these structures. All functions involve muscle activity: pupillomotor activity to control the amount of light and for contrast vision, the ciliary muscle for accommodation, the extraocular muscles for convergence and eye movements. Only if all of these elements are perfectly tuned up, fatigue-free fusion with stereopsis can be achieved without spending extra energy. If this is not the case, the motor deficits will shift to deeper regions and result in unnatural compensatory positions of the head with associated headache.

This is the case in many adolescent headache patients. Here, correction with glasses under cycloplegia and prismatic correction of the associated heterophoria, preferably measured using Haase’s measurement and correction method along with intact fusion, can help and will lastingly stop the headaches from occurring.

With headache, it is always best to first think of the eyes, before initiating demanding neurological or even psychiatric measures.