Comment on Sympathetic Headaches by Mark Kahrhoff.

Headaches directly related to eye strain are far from the most common type of headache. In fact, as a “competent” eye doctor who receives 100s of referrals from primary care phsyicians for headaches, I would say that 1% or less of those end up being related to eyes.

Most headaches of benign origin are due to sinusitis of some form. This is followed by tension-type headache and, quite frequently, headache due to dietary issues including changes in caffeine use or over-indulgence in foods and beverages containing artificial sweetener such as aspartame. There are several “sympathetic” headache syndromes that are less common but an important class of headache. Of course there are many migraine syndromes as well as headaches because of grave systemic or neurologic disease. Chronic headache should always lead you to your primary care physician first.

It is actually quite easy to determine if headaches are due to eyestrain. Headaches preceded by fatigue (sleepiness), associated with computer use or reading; headaches present during work weeks but absent on weekend when visual demands are less are more likely (not always) to be eye-related HA.

Incidentally, “opticians” never examine patients. Ophthalmologists are medical doctors with training in eye surgery. Optometrists are doctors with training in primary eye care including a full complement of medical eye issues, including headache. In the United States, most medical eye examinations are performed by optometrists.

The most important part of headache evaluation is the headache history. Any doctor with training in the eyes who is willing to take the time to take a thorough headache history is a real boon to patients with chronic headache. Unfortunately, many doctors — regardless of professional affiliation — rush into and out of exam rooms and fail to take the time to truly understand the patient’s headache.