Abstract
Objectives Refractive error has long been thought to be a cause for headache, however, historical research on this topic has major methodical limitations.
Often, patients with different headache types were examined together, making any direct conclusion between refractive error and headache difficult.
We investigate if surgical correction of refractive error with Topography Guided Photorefractive Keratectomy (TGPRK) and Collagen Cross Linking (CXL) alleviates headache in patients with keratoconus in an appropriately classified patient population, guided by the International Classification of Headache Disorders (ICHD-3).
Methods 40 patients who had keratoconus and required TGPRK and CXL met inclusion criteria.
Patients who met diagnostic criteria for headache as defined by the ICHD-3 were asked about the nature of their headaches and impact on quality of life by means of the Head Impact Score(HIT-6) questionnaire, both pre-operatively and post-operatively.
Results 24 of 40 patients reported headache pre-operatively.
Post-operatively, only 9 patients had diagnosable headaches(p<0.05).
The mean number of headache days per week decreased from 4.38 ± 2.37 days/week to 0.46 ± 0.72 days/week(p<0.05).
The mean duration of headache decreased from 10 8± 100.7 to 34.4 ± 63.5 minutes(p<0.05).
The consumption of analgesia decreased from 2.42±2.34 days/week to 0.56±1.16 days/week (p<0.05).
Post-operatively, HIT-6 scores decreased significantly. 61% of patients stopped analgesia altogether.
Conclusion Surgical correction of refractive error in patients with keratoconus can alleviate headache in a large proportion of cases, significantly improving quality of life.
It may be that the surgical treatment of keratoconus should be considered in patients as part of their headache management.
