Pediatric patients at a high risk of headache of ocular origin: the HAMS Score (Hyperopia, Astigmatism, Myopia, and Strabismus)

Abstract

Pediatric patients identified at increased risk for headache due to ocular refractive errors were evaluated to produce a diagnostic tool called the HAMS score that will help establish the likelihood of headache due to refractive errors.Methods Data on the ocular diagnosis and headache complaints of 726 pediatric patients of both sexes were obtained from the medical records of an ophthalmological service in Brazil (Hospital de Olhos Santa Luzia). Age, use of glasses, and ocular diagnosis were also considered to create an index based on the number of ocular diagnoses in a given individual (HAMS score) to verify their association with the incidence of headache. Once the database was finalized, it was then analyzed to identify the variables capable of predicting the occurrence of headaches, following which a profile of those at the highest risk was produced by comparison.Results Only the ocular diagnosis was significantly associated with headache as a function of sex, age, use of glasses, farsightedness, astigmatism, myopia, and strabismus, indicating the relative impact of each ocular diagnosis on the probability of headache. According to the HAMS score, strabismus is more likely to have headache (5.21), followed by hyperopia (3.10), myopia (2.67), and, finally, astigmatism (1.86). The findings showed that the presence or absence of refraction errors and strabismus is predictive of the occurrence of headache, particularly in a small group of patients (6.2%) where the probability of headache was 57.8%. Such patients were characterized by being younger, having a combination of strabismus, hyperopia, and astigmatism, and already be using corrective lenses.Conclusion The index based on the most common ocular diagnoses (HAMS score) is effective, and it has practical application in identifying children and adolescent patients with a greater or lesser propensity for headaches of ophthalmic origin.

Exploring Correlations between Headaches and Refractive Errors in an Optometry Clinic Sample

“…Hyperopia is the most frequent refractive error among headache patients in the present study and agrees with other studies (Akinci et al 2008;Das & Gupta 2017;Lajmi et al 2021;Gil-Gouveia & Martins 2002;Rydberg 2005;Wajuihian 2015;Vilela et al 2015;Thorud, et al 2021;Siqueira et al 2021). Hyperopia has consistently been associated with eyestrain/headache (Grosvenor 2007;Solan 1990;Rydberg 2005;Hendricks et al 2007).…”

“…Anisometropia was significantly associated with temporal headaches in the present study (Table 5). Padha & Qayum 2019, Akinci et al 2008, & Siqueira et al, 2021 found significant association between headaches and anisometropia although they did not specify the headaches anatomic location. Anisometropia has been reported to cause more headaches because of the difference in error between both eyes and due to the extra effort to accommodate to a different extent between both eyes (Grosvenor 2007).…”