Correspondence (letter to the editor): Causes Need to Be Comprehensively Investigated

Overuse or misuse of analgesics always give rise to the suspicion that the cause of the headache that needed treatment was not fully investigated and that the pain treatment was merely symptomatic, without the root cause being tackled. In my career of almost 50 years, as an ophthalmologist specializing in binocular vision disorders, I have encountered innumerable patients—including children of all ages—whose main symptom was headache, but in whom the actual cause was increased intraocular pressure (rarely), uncorrected hyperopia, astigmatism, associated heterophoria, latent microstrabismus, or the wrong glasses prescription. Those affected, but also the previously treating doctors of all disciplines were usually unaware of these associations. Consequently, analgesics were repeatedly prescribed in order to treat the symptom. Once the optometric defects were corrected, the headaches—with inevitable regularity—also disappeared.

Before headache medications are used, the patient’s eyes should be examined for glaucoma or visual defects. It is worth the effort.