Headaches are common and their cause is difficult to ascertain. There are a couple of ocular conditions that can exacerbate headaches. If the eyes are out of alignment (a condition called strabismus) the constant eye muscle strain of looking straight ahead can cause a tension headache. Prism glasses or eye exercises may help with this. If the eyes have a refractive error (like nearsightedness or farsightedness) the strain of focusing can also cause a headache. Updating glasses or contacts may help in these cases. There is also a condition called pseudotumor cerebri that causes headaches because the fluid pressure inside the skull is too high. This disorder is hard to diagnose short of doing a spinal tap and measuring the “opening pressure” of fluid coming out. However, IF the intracranial pressure is high, fluid tends to travel up the optic nerve and swelling can be seen at the optic disk inside the eye during a dilated retina exam. Ocular migraines are headaches associated with visual changes or “auras” and are usually secondary to harmless spasms of blood vessels at the eye and brain. Finally, in elderly patients, headaches associated with scalp tenderness or general malaise (not feeling well) can occasionally be associated with a more serious condition called temporal arteritis, which may require oral steroids.