Teens and Headaches Seem To Go Together

Sue Hubbard, M.D.

I just read an interesting study about teenagers with headaches. About 1 to 2 percent of adolescents have chronic daily headaches, defined as greater than 15 headache days per month for more than three months.

Once school begins, teen 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 school activities, sleep well once they fall asleep, and spend their weekends doing whatever it is all teens do.

I see very few teenagers who look like they're in "severe" pain, although they may insist, "My head is killing me" while chattering away about where it hurts, how often it hurts, etc. It's reassuring to watch their faces and expressions as they go into such detail. In these cases, it's important to obtain a good history to rule out any underlying pathology, as well as to inquire about family history of migraines.

In the study I reviewed, the authors followed adolescents ages 12-14 who met criteria for chronic daily headaches. They followed the group after both one and two years, then again after eight years. The results showed that after one year, 40 percent of the adolescents still complained of chronic headaches. After two years, only 25 percent reported headaches.

After eight years, only 12 percent of those studied 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.

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 a teen's headaches, it's best to discuss the natural history of chronic headaches.

It's 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 these headaches reduce with time, maybe as part of the natural 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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