When to Call the Pediatrician

Mild to moderate pain from tension headaches is one of the most prevalent medical complaints of the teen years. A tension headache typically comes on over the course of the day, producing a viselike pressure on both sides of the scalp and down the neck. “What happens is that the scalp muscles tighten around the skull,” explains Dr. John Kulig of Boston’s New England Medical Center, “usually in response to stress.”

Migraine headaches, seen in 10 percent of adolescents, particularly girls, are characterized as attacks—that’s how severe they are. When the pounding pain on one side of the skull is preceded by a visual disturbance, a person is said to have a migraine with aura. “The person will see bright, flashing lights, pinwheels or zigzag patterns,” says ophthalmologist Harold Koller, who adds that parents often mistakenly attribute the optical illusions and headaches to eye strain. An aura may subside within minutes or continue for hours, while the pain lasts for several hours, on average. A migraine without aura strikes suddenly and persists for anywhere from three hours to several days. Migraines may occur frequently, as often as several times a week, or rarely, with years between episodes.

There are many possible causes or triggers of migraines, including stress, various foods and the constriction of blood vessels in the head and neck, which reduce circulation to the brain. In 2000, researchers at the National Institutes of Health discovered another cause: a malfunction in the back of the brain. Apparently, a trigger stirs abnormally excitable brain cells into firing off tiny impulses. The electrical charges ripple throughout the brain and brain stem, stimulating pain receptors along the way.

Symptoms of Headaches May Include:

Tension Headaches

  • Constant, dull ache on both sides of the forehead
  • Sensation of tightness in the head, radiating down the neck

Migrane Headaches

Migraine with aura:

  • Visual disturbance called an aura
  • Throbbing, incapacitating pain that starts on one side of the head and occasionally envelops the other side
  • Drowsiness

Migraine without aura:

  • Throbbing, incapacitating pain on one side of the head
  • Mental dullness
  • Moodiness
  • Fatigue
  • Fluid retention
  • Sensitivity to light
  • Diarrhea
  • Nausea and vomiting
  • Drowsiness

Causes of Headaches

Headaches often accompany illnesses such as viruses, strep throat, allergies, sinus infections and urinary-tract infections. Other common causes include:

  • Extreme hunger or thirst
  • Not getting enough sleep
  • Specific foods and beverages, such as chocolate, hard and aged cheeses, pizza, yogurt, nuts, lima beans, processed meats, some fruits and fruit juices
  • Food additives (monosodium glutamate, nitrates, nitrites)
  • Certain nonprescription dietary supplements and medications, and prescription drugs (birth-control pills, tetracycline, excessive doses of vitamin A)
  • Food products and beverages containing caffeine (sodas, coffee, chocolate)
  • Alcohol, cocaine and other illicit substances
  • Eye strain, including sun glare
  • Fatigue
  • Tooth infections or abscesses
  • Hormonal changes during a girl’s menstrual cycle
  • Changes in the weather
  • Emotional stress, depression, anxiety, intense anger, extreme excitement
  • Noisy, hot, stuffy environments
  • Flickering or glaring lights
  • Strong aromas
  • Clenching or grinding teeth
  • Physical exertion
  • Head injury

How Headaches are Diagnosed

  • Physical examination and thorough medical history
  • More involved and/or invasive procedures such as CT scan, MRI scan, lumbar puncture, would be performed only if a serious condition was suspected

How Headaches are Treated

Headaches respond best to treatment when they’re still in their early stages. If your teen has a tension headache, encourage her to lie down and relax, with her head elevated slightly. A hot bath or shower can help to ease the pain, as can placing a warm or cold compress on the forehead and/or neck. For migraine sufferers, you want to minimize sensory stimulation: Turn off the lights in the room, close the curtains, ask family members to keep the noise level down and so on. A cold pack helps here too, but do not apply heat—that will only make the pain worse.

Drug therapy: Tension headaches and migraines frequently respond well to a single dose of the over-the-counter analgesics acetaminophen or ibuprofen. According to the American Council on Headache Education, acetaminophen gets down to business more quickly, but ibuprofen appears to provide superior pain relief. If the symptoms recur, the next step might be a prescription for one of the “triptans”: sumatriptan, zolmitriptan, naratriptan, rizatriptan. This family of drugs puts a halt to two in three migraines by blocking the action of the neurotransmitter serotonin. And because triptans are nonsedating, teens may be able to return to the classroom or to other activities more quickly, without having to sleep off the migraine. We never want to overmedicate, however, for fear of inducing rebound headaches. The phenomenon was discovered in the 1980s. Apparently, taking analgesics every day or every other day interferes with the brain’s own ability to battle pain. The net effect is that over time the teenager begins to experience more headaches between doses. What’s more, the medicines that once brought relief no longer seem as effective.

Put your finger on the trigger: Your pediatrician may suggest keeping a “headache diary” to help pinpoint the cause of your teen’s headaches. In it, she writes down the following information:

  • when the headache occurred
  • how long it lasted
  • what she was doing when the headache came on
  • foods eaten that day
  • amount of sleep the night before
  • any observations on what seems to make the headaches better or worse

Identifying and eliminating the precipitating factor of migraines—be it a certain food, a medication, a situation—can significantly reduce their occurrence. Some triggers, though, can’t be avoided, like the stress of school. When researchers at the Palm Beach Headache Center in Palm Beach, Florida, studied nineteen hundred migraine sufferers aged twelve to seventeen, they discovered a fascinating (though not entirely surprising) pattern: Of the seven days of the week, the rate of migraines was the lowest (9 percent) on Saturdays and peaked (20 percent) on Mondays.

Relaxation exercises, taught by your pediatrician or a mental health professional, can help kids to handle stress with greater resilience. Another mind body technique, biofeedback, has proved useful in reducing both the frequency and the duration of migraine headaches. Psychotherapy, too, may play a part in treating migraines.

Helping Teenagers Help Themselves

The tips below can help youngsters to avoid headaches:

  • Get the proper amount of sleep.
  • Eat regular meals, if possible. If not, snack frequently.
  • Exercise regularly.
  • Be aware of any pattern to your headaches that might help you to identify headache triggers.

Teen Tip:

Teenagers plagued by three or more migraines a month may be candidates for preventive (prophylactic) medicine, using antidepressants such as amitriptyline, as well as beta-blockers, calcium-channel blockers, or antiseizure medications.