Your Teen asked Dr. Mark Scher, pediatric neurologist at University Hospitals Rainbow Babies & Children’s Hospital in Cleveland, Ohio to set the record straight on headaches in kids.
Q: What kinds of headaches are there?
Scher: Believe it or not, there’s a whole book on the classification of headaches. But, basically there are two types to initially consider. First, there’s a primary headache, which is not caused by another underlying condition. Migraines and tension headaches are two common types of primary headaches. Next, there’s a secondary headache, which results from underlying conditions, such as ear, nose and throat infections, trauma to the head or neck, allergies, dental problems, or rarely brain tumors.
Q: So, primary headaches are much more common?
Scher: Yes, with tension-related headaches being the most common type of headache in teenagers and adults.
Q: How do you determine what type of headache it is?
Scher: Patients see the pediatric neurologist when the headache remains debilitating despite the best efforts of the primary care physician. In other words, it’s not your run-of-the-mill headache that is easily treatable with over-the-counter medication. As with all medical complaints, we need to begin with a complete history: When did the headache start? Was there some reason it began, like perhaps a head injury? How often does the headache occur and during the day or night? What, qualitatively, does it feel like? That’s how you determine what type of headache you have if it’s severe.
Q: Do different headaches feel different?
Scher: Yes. And the description of the headache offers us clues as to the type. For example, if it’s one-sided, pounding in quality with symptoms such as nausea and flashing lights, that’s probably a migraine. But, it’s not always that straightforward.
Q: How so?
Scher: It can be much more complex than just saying, that’s a migraine, that’s a tension headache, and so on. Children can suffer with multiple headache types for different or related reasons. For example, a teenager with a Type A personality who gets perfect grades, works five hours per night on homework, sleeps only four hours—oh, and by the way, is being bullied and seeing a psychologist for anxiety. Now while the migraine diagnosis may be part of the story, based on the symptoms, the whole story becomes more complicated. In this case, there is probably a tension trigger or a tension-related headache, in addition to the migraine.
The causes of headaches can be hard to pin down. Sometimes I consult with other professionals. For example, I may consult an ophthalmologist who can examine a patient’s eyes to assess if there is increased pressure on the brain, sometimes from a brain tumor. Or, I may work with an ear, nose and throat doctor to check for sinus infections, which is another secondary type of headache. Sleep problems and allergies can also cause headaches, and I may need assistance from a sleep medicine physician or immunologist/allergist. Anxiety and depression may suggest the need to refer to a mental health provider.
Q: How should parents evaluate a headache?
Scher: Start with the context when the head pain occurs. What was your teen like 30 minutes before the headache? Is it the end of the day, or the middle of the night? Is your teenager stressed about school, friends, teachers or family? The vast majority of headaches that present in the afternoon or evening are tension headaches. Are they taking a new medication? Did they get hit in the head at the soccer game? There may be other, more worrisome types of headaches. The context tells you a lot.
Q: When should parents worry?
Scher: With any headache associated with head trauma, parents should seek medical advice. In general, if your teen looks ill or is behaving oddly after any kind of injury, you should go to the emergency room. If the headache is new in onset and very severe—for example, waking your teen up in middle of night—let the doctor know right away. Tumors can present that way. If there’s a fever, stiff neck, and light sensitivity accompanying a sudden, severe headache, we might worry about meningitis. Again, get in touch with the doctor right away.
Q: What about frequent headaches?
Scher: Talk to your teen’s doctor. You can also keep a journal of the details of the headache to get a better idea of what may be causing them. Include details like time of day, what activity your teenager was doing, any foods they ate, medications they took, etc.
Q: What’s a migraine?
Scher: With a migraine headache, the pain tends to be more severe with a pounding sensation, and it is often associated with nausea, vomiting, and sensitivity to light.
Q: Why do some teens get migraines?
Scher: We don’t know exactly what causes migraines, but researchers suspect that they’re caused by a combination of genetic vulnerability, stresses in the environment, or health problems. We also know that hormones play a role, especially in adolescence when migraines tend to occur more frequently. More boys than girls get migraines before puberty. After puberty, that flips, and women are three times as likely as men to get migraines.
Q: How should we treat migraines in teens?
Scher: Don’t rush to prescription drugs. You can try Advil, but be careful of going overboard because too much medication can cause a rebound headache: a headache that is literally caused by the overuse or misuse of pain medication.
Q: When would prescription drugs be appropriate?
Scher: When over-the-counter medications aren’t working. Imitrex is often prescribed to abort or rescue a headache that has just started. Others with frequent migraines that come on without warning may benefit from daily preventive treatment, regardless of whether a headache is present. For example, migraines that overlap with tension headaches may call for preventive treatment with anti-depressant medications. Make these decisions with your doctor, and consider your teen’s quality of life.
Q: Are migraines for life?
Scher: No, not necessarily, especially if it’s just migraines. There are plenty of testimonials by people who once suffered with migraines but no longer do at older ages.
Q: Do lifestyle choices impact headaches?
Scher: Yes, they can, especially with teenagers who are more autonomous and may not be getting enough sleep, eating a healthy diet, or drinking enough fluids. Stress at home or school is another factor. Alcohol, especially wine, and marijuana can trigger migraines. Adequate sleep, healthy diet, hydration, and exercise can make a difference.
Q: What about head injuries in teen athletes?
Scher: There is much more awareness of head trauma now. If your teenager gets hit hard enough that they get a headache and it doesn’t go away, call the doctor. Your teenager may have a concussion and may need to take a break to let the brain heal. That being said, for some athletes, headaches can also be muscular or tendon related. For example, weight lifters can get muscle related headaches or a dancer may get headaches when doing a particular type of movement.
