How serious is my child’s headache?

It’s Monday morning and it’s not uncommon for your teen to complain of a headache, not wanting to go to school. Or you get a call from school at noon that your adolescent needs to be picked up because of a bad headache. But before you say, “Oh really….Again?” let me tell you some interesting facts about teen headaches. I’m sure most teens feel that everything about their life is stressful and gives them a ‘headache!’ But it is true that Mondays are the worst days for teenagers with migraine headaches and I’m talking about true, severe, and debilitating headaches, not just excuses to miss school.

In a study done with data from 35 headache clinics where data was analyzed  about headache patterns of 1,932 adolescents between age 12 and 17, it was noted that 20 % of teens  had migraine attacks most frequently on Mondays, 16% suffered most frequently on Tuesdays and Wednesdays,  and 9% suffer most frequently on Saturdays and holidays. The Monday spike was in fact due to the stress associated with the first day of the school week!

About 75 % of teens report at least one headache a month and the most common headachesHeadaches experienced by teens are called tension headaches. These are specifically related to everyday stressors like school, sports, extracurricular activities etc…  The pain is usually starts slowly on both sides of the head; it is a dull and steady pain like a band around the head. Tension headaches are commonly related to teenage lifestyle or habits such as:

  • lack of enough sleep
  • stress at school or at home, especially exams
  • lack of adequate hydration, heat stress
  • overexertion and lack of proper nutrition
  • too much screen time (like TV, video games, internet etc…)
  • loud music

Tension headaches cause mild to moderate pain and are frequently relieved by rest and over-the-counter medication such as Acetaminophen or Ibuprofen. Do not use Aspirin for any types of headaches in children.

Most parents worry that their child is suffering from migraine headaches. Migraines occur in about 20 % of teenagers and adults. It is more common in boys before age 7. After puberty, more girls are affected. Migraines are usually recurrent throbbing headaches that come on over a short time, moderate to severe pain on one or both sides of the head, with nausea or vomiting, light sensitivity, made worse with physical activity, and are not easily relieved by over-the-counter medicines. Migraines can be triggered by

  • Certain foods like chocolate, red wine, citrus fruits, dairy, beans, nuts, caffeine, and certain food additives( like MSG, artificial sweeteners)
  • Physical and emotional stressors, loud sounds, flashing light
  • Alcohol withdrawal
  • Skipping meals, dehydration
  • Weather changes
  • Girls sometimes experience migraines related to their menstrual cycle, either just before the start of their menstrual period or during their period.

Although migraines are quite debilitating during an acute attack, prompt recognition by the child and parent and treatment with proper medications can reduce the duration of these headaches. Sometimes a trip to the emergency room may be warranted to treat acute migraine headaches. Your pediatrician may also advice you to maintain a headache diary to help recognize the headache triggers.  In addition to medical treatment, lifestyle changes and avoidance of the triggers are very important in management of migraine headaches.

Headaches can also be secondary to other medical conditions like upper respiratory infections, sinusitis and rarely brain infection, brain injuries, and brain tumors. It can also be one of the symptoms of teenage depression where the headache is associated with severe mood changes, sleeping habits, loss of appetite, difficulty concentrating and declining social interactions and school performance.

Headaches are common in children, however brain tumors are not. So, when do you worry about a more rare cause of these headaches? Seek immediate medical care for  any of the following:

  • Headache that wakes your child in the middle of the night
  • Unusually horrible headache
  • Severe sudden headache
  • Associated head injury
  • Vision changes
  • Associated difficulties in walking,  dizziness, confusion, or weakness
  • Headaches with a high fever and /or neck pain

Persistent or worsening headaches may need a referral to a neurologist and further work up. Your child’s headache, if left untreated or if inadequately treated can be disruptive to normal life. We all know that ‘pain begets pain’. So, the faster we recognize these symptoms in our kids and seek treatment, the faster we can restore normalcy in their lives…. and ours too!

Shobha Bhaskar, M.D. About Shobha Bhaskar, M.D.

Shobha Bhaskar, MD is a pediatric hospitalist with St. Louis Children's Hospital and Washington University School of Medicine, who also sees patients at Children's Hospital facilities at Missouri Baptist Medical Center and Progress West Healthcare. Connect with Dr. Bhaskar on Facebook: ChildrensMomDocs and .

Comments

  1. Erik Campano says:

    How did they verify that the students weren’t faking it?

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