ASSOCIATION OF HEADACHE AND REFRACTIVE ERROR IN SCREEN USERS
DOI:
https://doi.org/10.71000/ehyjkq82Keywords:
Headaches, , Refractive error, Adult, Myopia, , Hyperopia, , Astigmatism, , Screen TimeAbstract
Background: Headache has emerged as a common health complaint in the modern digital era, with its prevalence rising alongside the increasing dependence on digital screens. Young adults are particularly vulnerable due to prolonged device use, which may exacerbate visual strain and uncorrected refractive errors. Refractive errors such as myopia, hyperopia, and astigmatism are recognized contributors to visual fatigue and are suspected to play a key role in screen-related headaches, thereby impairing overall quality of life.
Objective: The objective of this study was to assess the association between refractive errors and headache severity in individuals who use digital screens regularly.
Methods: A descriptive cross-sectional study was carried out over a four-month period at Riphah International University and Ghurki Trust Teaching Hospital, Lahore. A total of 132 participants aged 18–30 years were recruited using a non-probability convenience sampling technique, with equal distribution of myopia, hyperopia, and astigmatism (44 each). Inclusion criteria required refractive error within ±0.5D to ±3.5D, daily screen use exceeding two hours, and complaints of headache. Exclusion criteria included ocular pathology, systemic conditions, prior ocular surgery, and headaches due to addiction. Headache severity was measured using the HIT-6 (Headache Impact Test-6) questionnaire, while refractive errors were assessed through Snellen visual acuity, slit-lamp biomicroscopy, fundoscopy, auto-refractometry, and subjective refraction. Data were analyzed using SPSS version 26.0, with chi-square tests applied to evaluate associations.
Results: The mean age of participants was 21.3 ± 2.07 years, with a higher proportion of females (60.6%) compared to males (39.4%). Headache severity increased with longer screen exposure: mild headaches were most common in those with 2–4 hours of screen use (56.8%), moderate headaches in those with 4–6 hours (53.2%), and severe headaches in individuals exceeding 6 hours daily (62.5%). Refractive error type showed significant associations with headache severity. Among those with severe headaches, 61.4% had astigmatism and 43.2% had hyperopia, while only 4.5% were myopic. In contrast, myopia was more commonly associated with mild (38.6%) and moderate headaches (56.8%). Statistical analysis confirmed significant associations between both screen time and refractive error with headache severity (p<0.001).
Conclusion: The findings highlight that, refractive errors, particularly astigmatism and hyperopia, contribute substantially to screen-related headaches in young adults. Prolonged screen exposure further intensifies headache severity. Early identification and correction of refractive errors, coupled with awareness regarding safe screen habits, may reduce the burden of headaches and improve visual comfort in this vulnerable population.
References
Wajuihian SOJTB, Journal IO. Exploring correlations between headaches and refractive errors in an optometry clinic sample. 2024;20(1):1.
Wajuihian SO, Mashige KPJJoo. Gender and age distribution of refractive errors in an optometric clinical population. 2021;14(4):315.
Wajuihian SOJTB, Journal IO. Characterizing refractive errors, near accommodative and vergence anomalies and symptoms in an optometry clinic. 2022;18(1):76.
Ambah T, Abidoye FE, McCalla CA, Kalejaiye M, Ihunda IC, Onwua-maegbu VM, et al. Digital Age Headaches: Exploring the Neurological Impact of Screen Time and Blue Light. 2025;49(3).
Olson JA, Sandra DA, Colucci ÉS, Al Bikaii A, Chmoulevitch D, Nahas J, et al. Smartphone addiction is increasing across the world: A meta-analysis of 24 countries. 2022;129:107138.
Kumban W, Cetthakrikul S, Santiworakul AJIJoER, Health P. Smartphone addiction, screen time, and physical activity of different academic majors and study levels in university students. 2025;22(2):237.
Alotaibi MS, Fox M, Coman R, Ratan ZA, Hosseinzadeh HJIjoer, health p. Smartphone addiction prevalence and its association on academic performance, physical health, and mental well-being among university students in Umm Al-Qura University (UQU), Saudi Arabia. 2022;19(6):3710.
Plamondon A, McArthur BA, Eirich R, Racine N, McDonald S, Tough S, et al. Changes in children’s recreational screen time during the COVID-19 pandemic. 2023;177(6):635-7.
Kumar S, Pandey HJIJoS, Research H. Impact of 20-20-20 Rule and Daily Reminders in Relieving Digital Eye Strain. 2024;9(2):339-51.
Toombs E, Mushquash CJ, Mah L, Short K, Young NL, Cheng C, et al. Increased screen time for children and youth during the COVID-19 pandemic. 2022;3(59):1-19.
Singh P, Mishal A, Sunarait JSJNMCJ. Ophthalmic causes of headache among patients attending tertiary care center in Kathmandu, Nepal. 2021;23(3):235-40.
Hagen L, Gilson SJ, Baraas RCJSJoO, Science V. Vision status and reading test results in Norwegian adolescents. 2020;13(2):2-7.
Lund J, Berring-Uldum A, Colak M, Debes NMMJN. Headache in children and adolescents: the association between screen time and headache within a clinical headache population. 2022;53(04):221-6.
Kaur K, Gurnani B, Nayak S, Deori N, Kaur S, Jethani J, et al. Digital eye strain-a comprehensive review. 2022;11(5):1655-80.
Yang G-Y, Huang L-H, Schmid KL, Li C-G, Chen J-Y, He G-H, et al. Associations between screen exposure in early life and myopia amongst Chinese preschoolers. 2020;17(3):1056.
Cui L, Zhou H, Lou X, Chen T, Guo Y, Li J, et al. Effects of behaviors and surrounding environment on myopia before and during the COVID-19 pandemic: a longitudinal analysis of children and adolescents in China. 2024;32(7):1229-41.
Moyano DB, Sola Y, González-Lezcano RAJE. Blue-light levels emitted from portable electronic devices compared to sunlight. 2020;13(16):4276.
Fawad A, Humayun S, Ishaq M, Arzoo S, Mashhadi SF, Humayun Q. Assessment of Refractive Outcome of Photo Refractive Keratectomy in Myopia and Myopic Astigmatism. J Coll Physicians Surg Pak. 2022;32(3):329-34.
Tideman JWL, Pärssinen O, Haarman AEG, Khawaja AP, Wedenoja J, Williams KM, et al. Evaluation of Shared Genetic Susceptibility to High and Low Myopia and Hyperopia. JAMA Ophthalmol. 2021;139(6):601-9.
Liu X, Wang P, Xie Z, Sun M, Chen M, Wang J, et al. One-year myopia control efficacy of cylindrical annular refractive element spectacle lenses. Acta Ophthalmol. 2023;101(6):651-7.
Erdinest N, London N, Lavy I, Berkow D, Landau D, Morad Y, et al. Peripheral Defocus and Myopia Management: A Mini-Review. Korean J Ophthalmol. 2023;37(1):70-81.
Salzano AD, Khanal S, Cheung NL, Weise KK, Jenewein EC, Horn DM, et al. Repeated Low-level Red-light Therapy: The Next Wave in Myopia Management? Optom Vis Sci. 2023;100(12):812-22.
Reimelt C, Wolff N, Hölling H, Mogwitz S, Ehrlich S, Roessner V. The Underestimated Role of Refractive Error (Hyperopia, Myopia, and Astigmatism) and Strabismus in Children With ADHD. J Atten Disord. 2021;25(2):235-44.
Li SM, Kang MT, Wang NL, Abariga SA. Wavefront excimer laser refractive surgery for adults with refractive errors. Cochrane Database Syst Rev. 2020;12(12):Cd012687.
Downloads
Published
Issue
Section
License
Copyright (c) 2025 Ruhullah, Muhammad Aswad Ali, Muhammad Subhan , Muhammad Rehman , Ahsan Ali Khan , Umara gul (Author)
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
