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We work closely with your physician in evaluating your type of headache, potential visual causes of your headache, potential vision loss from the underlying cause of your headache, and treatments.


There are many types of headache.  We most commonly see patients with headaches from: 

Intracranial Hypertension (Pseudo-Tumor Cerebri)

Visual Strain based headache


Migraine is not just a bad headache.

Migraine is a neurological disease with incapacitating neurological symptoms. 

It’s typically a severe throbbing recurring pain, usually on one side of the head. But in about 1/3 of attacks, both sides are affected.

In some cases, other disabling symptoms are present without head pain.

Attacks are often accompanied by one, or more of the disabling symptoms: visual disturbances, nausea, vomiting, dizziness, extreme sensitivity to sound, light, touch and smell, and tingling or numbness in the extremities or face.

About 25% of migraine sufferers also have a visual disturbance called an aura, which usually lasts less than an hour.

In 15-20% of attacks, other neurological symptoms occur before the actual head pain.

Attacks usually last between 4 and 72 hours.

Headaches affect millions of Americans daily. Many variables causes headaches, including visual dysfunction, vascular injury or disease, hormone imbalance, traumatic brain injury, sinus infection and stress. We work with a  nationally recognized neurologist to address headache pain. We utilize a multi-disciplinary approach including medicine, occupational therapy, physical therapy and visual therapy for the evaluation and treatment. For more information, please our office.

Visual Causes of Headache

Headaches are a major reason for eye exam visits. There are many causes and types of headaches and the specific treatment depends on an accurate diagnosis. When headaches are visual in nature, they will tend to onset with use of the eyes and be present center to the brow and ocular region. These headaches tend to be a dull pain. Listed below are some of the more common visual causes of headaches and an introduction to treatment.




Astigmatism refers to an unequal focusing of the eye because the eye is more oval than round shaped. There is no focal point and thus the eye receives a distorted image. In an effort to clear the image, the eye constantly adjusts its focus. The resulting muscle effort, distortion and constant re-focusing causes eye strain and headache. There are multiple types of astigmatism: horizontal (“with the rule”), vertical (“against the rule”) and oblique. Vertical and oblique tend to be the most problematic in causing headaches with even a relatively small amount capable of causing the eyestrain and headache.


Hyperopia refers to “far-sightedness”. A person who is hyperopic (especially in lower amounts) can relatively see better at a distance than at near. They need to accommodate (focus) their eyes to see clearly at distance and excessively accommodate in order to see at near. This excessive accommodation leads to eye muscle strain and headache. Treatment is with lenses.


Presbyopia is the age-related loss of focusing. It begins to show up in the early to mid forties and progresses until the early fifties. During this time near vision becomes increasingly difficult. This is caused because the lens in the eye (which performs the fine focus of the eye) does two things. First, it continues to grow throughout life so it becomes thicker and less able to change shape, and second, the lens fibers lose their elasticity. The extra effort to focus can cause eyestrain and headaches. Treatment is with lenses.


Anisometropia refers to unequal prescription needs between the eyes. In a special case, anti-metropia, one eye will be near sighted and the other farsighted. The difference can cause a host of focusing and eye coordination problems, which in turn cause eyestrain and headache. Treatment is with appropriate ophthalmic lenses, or contact lenses.


Aneisokonia is a special type of anisometropia where there is so much difference between the eyes that they cause a significant difference in magnification of images seen between the eyes. When this magnification difference becomes excessive, generally more than about 4%, the effect can cause disorientation, eyestrain, headache, focusing problems, and even dizziness and balance disorders. Treatment is with contact lenses, or special magnification size matched lenses called isokonic lenses.

Accommodative Disorder

Accommodation (focusing) problems can cause headaches. Difficulty with how the eyes focus can cause blur, muscle spasm, eyestrain, and fatigue thereby leading to a headache. Options for treatment include lenses to aid accommodation and therapy to improve muscle strength, function and flexibility.

Binocular Disorder

Binocularity refers to how the eyes work together as a team. It is the coordination of convergence and divergence (eye teaming and alignment) with accommodation. Deficiencies can cause eyestrain, double vision, muscle spasm and fatigue with headaches coming on secondarily. Treatment includes lenses; prisms and therapy to improve muscle strength, function and flexibility.


Glaucoma is an eye disease that causes a progressive loss of sight from increased intra-ocular pressure. The most common type, open angle glaucoma, is painless and slowly progressive. It is treated with eye drop medication, laser, and occasionally surgery. Another type of glaucoma is called acute angle closure. This is of sudden onset and causes extreme eyeache and headache. This is an ocular emergency and is aggressively treated with medication to break the attack.


Iritis is an inflammation of the iris muscle inside of the eye. Cause of the inflammation can be from trauma, autoimmune disease, systemic disease, and sometimes is unknown. It causes a red and sore eye that is sensitive to light. Vision may become dimmed. A deep boring headache in the eye and temple area commonly accompanies the condition.

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