Teens' Chronic Headaches

I recently read an interesting study about teenagers with headaches. About 1-2 percent of adolescents have chronic daily headaches, defined as greater than 15 headache days per month for greater than 3 months. Once school begins, teens stress levels increase with each week of school, and with that come more complaints of chronic headaches. It's not unusual for me to see several teens a week who complain that they have headaches every day.

Despite these persistent headaches, the majority of adolescents continue to participate in their school activities, sleep well once they fall asleep, and stay active on weekends.

I see very few teens who look like they're in "severe" pain, although they say their head is "killing" them. They chatter away about where it hurts, how often it hurts, etc. In these cases, it is important to obtain a good history to rule out any underlying pathology, as well as to inquire about any family history of migraines.

In the study I read, the authors followed adolescents ages 12-14 years who met criteria for chronic daily headaches. They followed the group after both 1 and 2 years, and then again after 8 years.

The results showed that after 1 year, 40 percent of adolescents still complained of chronic headaches. After 2 years, only 25 percent reported headaches. After 8 years, only 12 percent reported chronic headaches. Most participants reported substantial or some improvement in headache intensity and frequency during the 8-year follow-up.

The most significant predictor for ongoing problems with headaches was the onset of chronic headaches before the age of 13. For the most part, 75 percent of adolescents with chronic daily headaches improved over the 8-year period, which is quite reassuring.

This study seemed to confirm that teens and headaches go together. If a good history and physical exam is performed and there seem to be no underlying problems that contribute to their headaches, it's best to discuss the natural history of chronic headaches.

I think it's also important to spend time with adolescents to explore ways to alleviate stress as a trigger for chronic daily headaches.

Basic changes in lifestyle, such as healthy eating, regular exercise, and a good night's sleep will often help reduce headaches. Relaxation techniques and cognitive behavioral therapy may also be utilized. At least we know that the headaches reduce with time, and perhaps are just as part of the maturational process, like many things!

Dr. Sue Hubbard is a nationally known pediatrician and co-host of "The Kid's Doctor" radio show.

 

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