Aim: To evaluate the association of Binocular Anomaly with Headache. Methods: The prospective cross-sectional study which was carried in the Department of Ophthalmology, Patna Medical College and Hospital, Patna, Bihar, India for 15 months. There were 100 patients with complaints of headache were included in this study. Visual acuity was tested at 6 meters by Snellen’s chart and after refraction only the emmetropic patients were included in the study. A slit lamp examination of the anterior segment was done and ocular tension was recorded by applanation tonometer. Fundus fluorescein angiography and OCT for retinal evaluation and Humphrey field charting for glaucoma patients was done if needed. Results: Majority of patients were young adults in the age group of 20-30yrs (N=48); Females outnumbered males in a ratio of 1.85:1 with 35% males and 65% females. Pain topography showed frontal headache (44%) to be the most common presentation followed by hemicranial type of headache (34%). On orthoptic evaluation, an altered AC/A ratio was found in 73% of individuals complaining of headache, having either low (41%) or high (32%) AC/A ratio (p < 0.0001). Out of 100 patients, 40% pts were suffering from convergence insufficiency where as 32% had convergence excess and only 28% had normal convergence range. Direct proportion was seen between Convergence Insufficiency and low AC/A ratio and also between convergence excess and high AC/A ratio (p = 0.000) Accommodation insufficiency was seen in 46% of patients while accommodation excess was present in 36% of patients. Contrary to convergence, accommodation was inversely proportional to AC/ A ratio. Accommodation insufficiency being more common with high AC/A ratio (67.39%)whereas accommodation excess was seen more in patients having low AC/A ratio (83.33%) p=0.0001. Fusional vergence findings showed normal vergence in only 20(20%) patients. Reduced negative fusional vergence was seen in 38% patients and was more commonly associated with high AC/A ratio (39%), while reduced positive fusional vergence was present in 42% patients and was more common with low AC/A ratio 36 (85.71%). Conclusion: Headache was more common in females and was associated with exophoria, convergence insufficiency and inadequate positive fusional vergence at near fixation.