This chapter addresses headaches attributed to heterophoria or heterotropia, common but often overlooked conditions, and their role in headache etiology. It provides an in-depth exploration of clinical presentations, diagnostic approaches, and management strategies, with a particular focus on pediatric considerations and the introduction of the hyperopia, astigmatism, myopia, and strabismus (HAMS) Score as a diagnostic tool. The aim is to equip clinicians with practical insights for identifying and managing these complex cases, thereby improving patient outcomes.