Headaches in Children and Eye Checks

Headaches in children can have many causes, and most are not serious. Sometimes an eye problem is part of the picture. At other times, the right next step is a review with the child’s paediatrician. Knowing what an eye examination can check helps families ask better questions without assuming that every headache begins in the eyes.

This guide follows information from the American Association for Pediatric Ophthalmology and Strabismus. It explains common reasons children may get headaches, when an eye doctor may be involved, and what to share at an appointment. It cannot identify the cause of a particular child’s symptoms.

Headaches can have more than one cause

Children may get headaches for several reasons. AAPOS lists migraine, stress, a blow to the head, sinus problems, eye problems and some foods with certain additives. These possibilities do not mean that a parent can identify the cause from one symptom.

A headache can also happen while a child is dealing with a busy school week or changes at home. Mention stress or a recent head injury to the doctor. These details can help the clinician decide what questions to ask and whether any further checks are needed.

Many childhood headaches are not caused by an eye condition. An eye check can answer useful questions, but it is only one part of a wider medical assessment. Begin with the child’s doctor if you are unsure where to start.

Begin with the child’s doctor

A paediatrician can assess a child with headaches and decide what the next step should be. Depending on the symptoms, a doctor may consider tests, special pictures, a headache diary or a referral to a neurologist. The choice depends on the child and the findings at the appointment.

Tell the doctor when the headaches began and how often they occur. Mention whether the child recently hit their head. Also share any stress at home or school that may be relevant. A child may not describe these details clearly without a parent’s help.

Do not wait for an eye appointment to mention a new problem to the paediatrician. The doctor can decide whether an eye assessment should be part of the plan. If the child already sees an eye doctor, share that contact and any recent examination results.

When an eye examination may be considered

AAPOS explains that a child may be sent to an ophthalmologist when the doctor cannot find the reason for the headaches. The eye doctor can perform a full eye examination and check two important things. One is whether the child needs glasses. The other is how well the eyes work together.

That referral does not mean the headache must be caused by poor sight. It is a way to assess possible eye-related factors after considering the child’s wider health. The family doctor remains involved if the eye findings do not explain the problem.

Some children already have signs that their sight or eye movements need attention. For example, a parent may notice a child struggling to see the board at school. A guide to signs a child may not see the blackboard clearly describes observations worth sharing with an eye doctor.

What the eye doctor checks

The assessment can look at whether a child needs glasses and whether both eyes work together comfortably. The doctor may ask about reading, close work, blurred vision, tired eyes or double vision. Describe what the child experiences in their own words where possible.

Children do not always use adult terms for a vision problem. A child might say that words move, a page becomes blurry or reading feels tiring. They may hold a book very close or avoid a task that requires looking at small print. These observations do not prove an eye condition, but they help the clinician understand what happens.

If the doctor plans to use drops or take images, ask what each step is for. A separate guide explains what a dilated eye examination checks. It can help families prepare questions before a visit.

Focusing close up can take extra effort

Some children are farsighted, which is also called hyperopia. AAPOS explains that a child with hyperopia may need to work harder to see things up close. That extra effort can cause headaches. Glasses can sometimes help.

This is one reason a child’s reading habits may matter during an eye assessment. Tell the doctor if headaches tend to appear while reading, drawing or doing other close work. Share whether the child also reports blurry sight or tired eyes. The clinician can check whether focusing is part of the picture.

Do not assume that a child needs glasses simply because reading brings on a headache. A proper examination is needed to assess the eyes. If glasses are recommended, ask how they should be used and when the child should return for review.

When the eyes do not work together well

AAPOS describes convergence insufficiency as a problem with how the eyes work together when looking at something close. It can cause double vision, blurry vision, tired eyes and headaches. The symptoms may be more noticeable during a long period of reading.

A child may stop reading, lose their place or say that the words are hard to keep clear. They may also complain that their eyes feel tired. Those signs can have other explanations, so they are not enough to diagnose convergence insufficiency at home.

An eye doctor can assess how the eyes work together. AAPOS says that eye exercises can sometimes help and that some children may need glasses. The right approach depends on the examination. Do not start exercises or use another child’s glasses without advice from the clinician.

If a child reports double vision, tell the doctor rather than treating it as ordinary reading fatigue. A separate guide to squint signs and assessment in children may help you describe changes in eye position or movement at an appointment.

Migraines can affect more than the head

Some children have migraine headaches. AAPOS says a child with migraine may be sensitive to light and sound. Some children also see unusual shapes during a migraine headache.

Tell the doctor about these features if they occur. Note whether the child seeks a quiet or darker place, whether sounds feel uncomfortable, and whether visual shapes appear before or during the pain. These observations may help the clinician understand the pattern.

Visual symptoms do not automatically mean that a child has an eye disease. They can occur with migraine, and other explanations may also need consideration. The doctor can assess the whole picture and decide whether an eye examination or another review is useful.

Other eye conditions may also matter

AAPOS notes that eye infections, eye inflammation and high pressure inside the eye can cause headaches. These conditions need clinical assessment. A child’s headache alone cannot show which one, if any, is present.

The same source mentions that extra fluid around the brain is a rare problem. It is not an eye problem, but it can sometimes show extra fluid and pressure in the eyes. This is another reason to keep the child’s doctor involved rather than relying only on an eye appointment.

Share changes that happen alongside the headache, including a difference in sight or eye comfort. The clinician can decide whether those details change the assessment. Avoid trying to interpret a child’s symptoms by comparing them with another person’s diagnosis.

Keep a simple headache diary

AAPOS says a doctor may ask a family to keep a headache diary. A short record can make it easier to describe a pattern at the next visit. Write down when a headache starts, how long it lasts and what the child was doing beforehand.

You can also note whether the child mentions blurry or double vision, tired eyes, sensitivity to light or sound, or unusual shapes. Include a recent head injury or a stressful event if it may be relevant. Keep the record factual and let the doctor interpret it.

A diary is not a test and cannot identify the cause by itself. It is a memory aid for a conversation with the clinician. If keeping a detailed record becomes stressful, use a few brief notes instead of trying to document every minute.

What to share at the appointment

Before the visit, think about what the child has said and what you have observed. Mention when headaches happen, how often they return and whether they appear during close work. Describe any recent blow to the head, stress at home or school, and changes in sight.

Bring the child’s glasses if they have them. Share the date of the last eye examination and any advice already given. If the child has a headache diary, take it along. These details can help the doctor decide whether to check focusing, eye coordination or other parts of the child’s health.

Ask what the examination found and what should happen next. If the clinician recommends glasses, exercises, tests or a referral, ask who will explain the plan and when to return. Clear instructions can prevent a family from having to guess about follow-up.

If an eye examination does not explain the headache

An eye doctor may find that the eyes do not explain the child’s headaches. AAPOS says the child may then return to the paediatrician for more tests or see a neurologist. That next step keeps attention on the child’s wider health.

Ask the eye doctor to explain the result in plain language. Find out whether the paediatrician will receive the findings or whether your family should arrange the next appointment. If the headaches continue, share the pattern and any new symptoms with the child’s doctor.

Do not treat a normal eye examination as proof that the headaches are imagined. It only means that the eye assessment did not find an explanation. The doctor can consider other causes and decide what should be checked next.

Use the right route for questions

For an individual child, speak with the clinician who knows their medical history. An online article cannot examine a child, diagnose a headache or decide which tests are needed. Contact the child’s doctor if symptoms continue or you are unsure what to do next.

For a general enquiry about PEBS Hospital, use its children's headache and eye-check enquiry page. It is not an emergency service and cannot replace the child’s paediatrician. Readers who wish to support PEBS can visit the Donate page.

The useful question is not only whether a child needs an eye check. It is also what the eye doctor can assess and who will guide the family if the eyes do not explain the headaches. Start with the child’s doctor and keep the follow-up clear.

This article is general information and does not replace an examination by an eye doctor.