{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,12]],"date-time":"2026-09-12T17:53:05Z","timestamp":1789235585773,"version":"build-2803163510"},"reference-count":31,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2024,1,25]],"date-time":"2024-01-25T00:00:00Z","timestamp":1706140800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Purpose: To investigate if topography-guided photorefractive keratectomy (TGPRK) alleviates headache, particularly headache attributed to refractive errors (HARE) in keratoconus. Methods: Patients diagnosed with keratoconus undergoing TGPRK for refractive correction were included. Best spectacle corrected visual acuity (BSCVA) using the logMAR scale and refractive error were measured. Patients answered a questionnaire exploring headaches, characteristics, treatment, and the Headache Impact Test (HIT-6) before and 6 months after the surgery. Results: 40 patients were included. Preoperatively, 24 patients (60%) met criteria for headaches: five for migraine, 14 for HARE, and five for tension-type headache (TTH). Patients with headaches preoperatively were more likely to require bilateral TGPRK, and the mean sphere and cylindrical power were higher. Postoperatively, 15 out of the 24 patients of the headache group experienced complete resolution of headaches, and only nine patients met diagnostic criteria for headaches: two for migraine, six for HARE, and one for TTH. The number of headaches reduced from 4.4 \u00b1 2.4 to 0.5 \u00b1 0.7 days\/week (p &lt; 0.001). Headache duration decreased from 108.5 \u00b1 100.7 min to 34.4 \u00b1 63.5 min (p = 0.002). Postoperatively, the consumption of analgesia decreased. The HIT-6 revealed an improvement in the quality-of-life post-procedure (p &lt; 0.001). Conclusions: Surgical correction of irregular astigmatism in patients with keratoconus can alleviate or resolve headaches in a large proportion of patients, resulting in an improvement in their quality of life. Physicians should consider keratoconus in patients fitting criteria for HARE not alleviated by spectacle correction and suboptimal vision in glasses.<\/jats:p>","DOI":"10.3390\/jcm13030690","type":"journal-article","created":{"date-parts":[[2024,1,25]],"date-time":"2024-01-25T06:54:12Z","timestamp":1706165652000},"page":"690","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Headache Attributed to Refractive Error: Improvement after Topography-Guided Photorefractive Keratectomy with Corneal Cross-Linking in Patients with Keratoconus"],"prefix":"10.3390","volume":"13","author":[{"given":"Nigel Terk-Howe","family":"Khoo","sequence":"first","affiliation":[{"name":"Save Sight Institute, Faculty of Health and Medicine, The University of Sydney, Sydney, NSW 2050, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2178-6164","authenticated-orcid":false,"given":"Barbara","family":"Burgos-Blasco","sequence":"additional","affiliation":[{"name":"Ophthalmology Department, University of British Columbia, Vancouver, BC V5Z 1J9, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angelique","family":"Antoniou","sequence":"additional","affiliation":[{"name":"Narellan Eye Specialists, Narellan, NSW 2567, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bronwyn","family":"Jenkins","sequence":"additional","affiliation":[{"name":"Royal North Shore Hospital, Sydney, NSW 2065, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Clare L.","family":"Fraser","sequence":"additional","affiliation":[{"name":"Save Sight Institute, Faculty of Health and Medicine, The University of Sydney, Sydney, NSW 2050, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gregory","family":"Moloney","sequence":"additional","affiliation":[{"name":"Discipline of Ophthalmology, Sydney Medical School, The University of Sydney, Sydney, NSW 2006, Australia"},{"name":"Sydney Eye Hospital, Sydney, NSW 2000, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,1,25]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1186\/s10194-022-01402-2","article-title":"The global prevalence of headache: An update, with analysis of the influences of methodological factors on prevalence estimates","volume":"23","author":"Stovner","year":"2022","journal-title":"J. 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