Association of Headache and Refractive Error in Screen Users

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.