Srinivasan Shanmugam1, Sudhakar Duraiswamy Krishnamoorthy2

Headache or cephalgia is one of the commonest symptoms causing pain in head above eyes or the ears, behind the head in the occipital region or in the back of the upper neck causing pain as well as disability to an individual.
WHO reports around 47% of adults worldwide will have experienced headache in the last year. Headache maybe primary or secondary. Tension headache is more common type of primary headache. Almost, 90% of adults have tension headache and it is more common in females than males. Migraine headache is third most prevalent disorder worldwide and ranked as seventh highest cause of disability. Migraine headaches are the second most common type of primary headaches, whereas cluster headache, a relatively uncommon type of primary headache affecting less than 1 in every 1000 adults.1 Many people suffer from mixed headache disorder in which tension headache or secondary headache may trigger migraine.
Headache on 15 or more days in every month affects 1.7-4% of the world adult population. Hospital-based studies of migraine shows India is home over 16% of world inhabitants suffering from migraine.
In our study, total screening of 1200 cases was done with headache symptomatology reported to Eye OPD directly as well as referred from ENT, Medical, NeuroMedical, Surgical, Neurosurgical, Psychiatry, Orthopaedics and Trauma Ward. A detailed clinical examination and ophthalmological examination was done in 1200 cases.
Sexual prevalence in our study indicated female with increased prevalence of 46.67% compared to male of 36%. Among 30 cases of migrainous headache with or without aura, the sexual prevalence in our study has female-to-male ratio as 2:1 (female - 20 cases and male - 10 cases). No cluster headache disorder was reported in our study. Among the tension headache presented with ocular manifestations like association of the refractive error, redness, burning sensation, the female prevalence among the adolescent group was noted. Among the study age group of 10-70 years, increased prevalence between 10-30 years age group was noted with 873 cases (72.75%). Among this age group, ocular causes for headache like uncorrected refractory errors like various types of astigmatism as well as hypermetropia with asthenopic symptoms were present. The total number of refractory error cases detected were 407 in number out of 560 cases of ocular causes of headache (72.68%). The overall percentage of refractory error cases among 1200 screening is 33.92%. Next to refractory error, dry eye detected cases were 110 out of 1200 (9.17%). Third increased prevalence case was muscular imbalance and convergence insufficiency with or without association of refractory errors with 95 cases (7.92%). Acute congestive stage of primary angle closure glaucoma and subacute angle closure glaucoma had 3 cases each as per our study.
The headache is multifactorial in origin and the ophthalmologist may play a vital role in establishing the final diagnosis of headache. The WHO reports around 47% of adults worldwide will have experienced headache within the last year. It is estimated that 50% of people experiencing headache self-treat rather than visiting a health care provider.