Migraines and Headaches in Teens

What's Normal and What's Not

Headaches and migraines in teens are one of the most common health complaints. By the time your teen is 15 years old, he or she has probably had at least one significant headache. By the age of 18 years, more than 90 percent of teens have experienced a headache; girls experience headaches more often than boys during the adolescent years. Usually, headaches are just a pain, but sometimes they can mean that something more serious is happening.

Types of Headaches

Not every headache is caused by the same problem in the body. There are many possible causes of headaches and they're typically classified into two types: primary and secondary.

Primary headaches occur by themselves, with no other medical condition contributing to their manifestation. These include migraines, tension-type headaches, and much less commonly, cluster headaches. The causes of these headaches are unknown and are still being studied. From dysfunction of neurons in the brain to changes in the vessels supplying the brain with blood, there are thought to be a number of mechanisms that contribute to primary headaches.

Secondary headaches occur as a symptom of another issue in the body. The most common cause of these headaches in teens is a severe infection such as influenza, sinusitis, or an upper respiratory infection. Secondary headaches can also be caused by medication use or overuse, meningitis, head injury, high blood pressure, stroke, increased pressure in the head, an abscess, a brain tumor, or a brain hemorrhage. These headaches happen with far less frequency than primary headaches.

Headache Patterns

If your teen has headaches or has just gotten his or her first one, it's helpful to know how to classify it. This can help you determine if it needs immediate attention or not, as well as be beneficial to you when you discuss your teen's headaches with his or her doctor.

Headaches happen in a variety of patterns, but there are four common ones:

  • Acute headache: This is the first headache that a person has. It eventually resolves, with or without treatment.
  • Acute recurrent headache: This is when that first headache goes away completely but returns at some point in the future. The second one resolves completely and the pattern continues.
  • Chronic daily (non-progressive) headache: This is a headache that tends to be constant or happens most days. This headache doesn't get progressively worse over time.
  • Chronic progressive headache: This headache gradually gets worse over time. The headaches come more frequently, become more intense, or both.

Chronic progressive headache is one of the most concerning types, and you should take your teen to a doctor right away if you suspect it.

When a Headache Is a Migraine

Migraine is a neurological disorder that involves acute, recurrent headaches with moderate to severe pain. The two main types are migraine without aura (the most common) and migraine with aura.

As a parent or teen with headaches, you might be worried that the headaches are migraines. Part of the problem is that people think migraines are horrible and unmanageable. Although they can be unpleasant and disruptive, migraines don't have to be debilitating.

Symptoms of a migraine include:

  • Nausea or vomiting
  • Throbbing or pulsating head pain
  • Sensitivity to light (photophobia)
  • Sensitivity to sound (phonophobia)
  • Pain on both sides of the head, though as teens get older, this will likely change to the adult pattern of pain on one side of the head
  • Stomach pain
  • The head pain gets worse with activity
  • Aura (visual, sensory, or motor)

An aura is a symptom or a few symptoms that occur right before a migraine. It can be flashes of light with or without loss of vision, numbness or tingling in a part of the body, weakness, or even altered consciousness.

This is just a quick summary of when a headache might be a migraine, but it's helpful to have an idea of whether or not your teen's headache is truly a migraine.

If you have a family history of migraine, it's more likely that your teen's headaches are migraines. But as long as there aren't two or more of the above-listed symptoms that usually come with a migraine, it probably isn't one. If these symptoms sound familiar, talk to your pediatrician or family provider about your concerns.

Symptoms of Serious Headaches

Headaches are painful and disruptive, and they can sometimes be a sign of a serious problem. Some signs that a headache may indicate that there's a bigger medical issue include:

  • A chronic and progressively worsening headache
  • A headache that feels like the "worst headache” your teen has ever had
  • Unusual clumsiness or difficulty walking
  • Problems thinking, seeing, or speaking
  • Headaches or vomiting upon awakening in the morning
  • Stiff or painful neck

If your teen has any of the above symptoms, his or her doctor immediately. If your provider cannot see your teen right away, or the headache gets worse, a trip to the emergency room might be in order.

As always, your healthcare provider knows you and your family best, so consult him or her with your questions or concerns.

Diagnosis

Emergency cases aside, to diagnose a headache disorder, your teen's doctor will do a physical examination, a neurological examination, and get a detailed history of your teen's headaches.

It's helpful if you can keep a headache diary for at least a month before your teen's appointment so your doctor can look at factors like the time of day the headaches occur, how severe they are, where the head pain is, other symptoms that occur, and what might have triggered them, such as stress, not getting enough sleep, or missing a meal.

Another way to help your teen's doctor understand your teen's headaches is by using the PedMIDAS scale. This short quiz was adapted for children between the ages of 4 and 18 years from the MIDAS scale, which is used for adults. It can help you explain to your provider how severe and/or debilitating the headaches are for your teen. Between the PedMIDAS scale and headache diaries, your teen's doctor will likely appreciate the extra help at his or her next appointment.

If your doctor suspects from the neurological exam that your teen's headaches are a secondary type, your teen may have further testing to rule out other conditions that could be causing the headaches. Depending on what the doctor is looking for, these tests might include brain imaging, blood tests, or a lumbar puncture (spinal tap).

Treatment

There are several options to treat headaches and migraines.

Over-the-Counter Pain Relievers

Over-the-counter analgesic (pain) medications like Tylenol (acetaminophen) or Motrin/Advil (ibuprofen) can be effective for some teens. The recommended dose for your son or daughter will be on the bottle, or you can ask your pediatrician about an appropriate dose.

The best time to take one of these medicines is at the beginning of a headache, when it isn't as painful. If the medication is taken after a headache has come on and gotten worse, it's harder to treat.

Avoid Aspirin

If your teen is under the age of 16 years, be extremely cautious about giving him or her aspirin or aspirin-containing medications unless your doctor tells you to. Aspirin and other medications from the salicylate family of drugs can lead to a rare but serious disorder called Reye's syndrome.

Prescription Medications

If your teen has migraines and over-the-counter medications don't help, he or she may need something stronger, such as a prescription medication called a triptan. Examples of triptans include Zomig (zolmitriptan), Imitrex (sumatriptan), Axert (almotriptan), and Maxalt (rizatriptan).

For teens who have recurrent headaches or migraines, more than four to six per month, you may want to consider a preventive medication that he or she takes on a daily basis. Types of preventive medications for headaches in teens include:

  • Periactin (cyproheptadine), an antihistamine
  • Elavil (amitriptyline), an antidepressant
  • Depakote (valproic acid) or Topamax (topiramate), anticonvulsants
  • Inderal (propranolol), a beta blocker
  • Vitamin B2 (riboflavin)

Your teen's doctor can help you evaluate if he or she needs preventive medication based on how debilitating the headaches or migraines are, how often they occur, other health conditions your teen has, and how much (or little) over-the-counter medications help.

Complementary Alternative Medicine (CAM)

Limited studies have been done on non-pharmacological ways to treat children and teens with headaches, but so far, these options have shown noticeable effects on the frequency of headaches. Alternative therapies include methods like:

  • Acupuncture
  • Mindfulness
  • Cognitive-behavioral therapy (CBT)
  • Transcranial magnetic stimulation (TMS)
  • Progressive muscle relaxation
  • Deep breathing
  • Meditation
  • Massage

A 2018 review of these alternative treatments for older kids and teens found that biofeedback, CBT, TMS, mindfulness-based interventions, and multi-modal therapies resulted in a reduction of headache frequency from between 34 percent and 78 percent, a similar outcome to kids and teens treated with medication.

More research needs to be done, but it's possible that CAM therapies will replace medications as first-line therapies for kids and teens in the future.

Lifestyle

Encourage your teen to adopt healthy lifestyle habits that can help reduce or prevent headaches and migraines, including:

  • Getting adequate sleep every night
  • Exercising regularly
  • Eating a healthy, well-balanced diet that includes plenty of vegetables, fruits, and whole grains
  • Managing stress by learning relaxation techniques, stretches, and healthy ways to cope
  • Taking regular breaks when physically active, sitting for long periods of time, or looking at a screen for a long period of time

Prevention

The best way to treat a headache is to avoid it. Headaches and migraines can be triggered by an event, food, drink, or something in your environment. Common headache triggers include:

  • Not getting enough sleep
  • Stress
  • Certain foods like chocolate, red wine, citrus fruit, dairy, beans, nuts, and fatty foods
  • Food additives like monosodium glutamate (MSG), which is found in Chinese food and processed foods; nitrates, found in hot dogs and luncheon meats; aspartame, a sugar substitute; and tyramine, found in certain wines, aged cheeses, dried or pickled fish, yogurt, and sour cream
  • Too much caffeine or caffeine withdrawal
  • Alcohol or alcohol withdrawal (hangover)
  • Environmental changes like bright, glaring, or flickering lights, strong odors, or changes in weather
  • Not eating enough food or not drinking enough fluids
  • Smoking
  • Changes in regular schedule
  • Hormones (many females, including teens, find that they get headaches at certain points in their menstrual cycle)
  • Prescription medications

Your teen may have one trigger or several. Once triggers are identified, his or her headaches will likely greatly decrease or perhaps even go away if these triggers are avoided. Since teens make a lot of choices on their own, it's important to help educate them to this end so they can make smart decisions and realize that they play a big role in managing their condition.

If you or your teen aren't sure what his or her triggers are, if you haven't already, try keeping a headache diary as discussed previously. This lets your teen track the headaches and figure out what might be behind them.

Try the diary for a month or so. If a pattern emerges, then you can try to eliminate the trigger. Keep the diary longer if there is no clear pattern, or if you think the headaches are related to your teen's menstrual cycle.

Bring the diaries along to your teen's next doctor visit. They can provide a lot of helpful information you might otherwise forget while in the office.

A Word From Verywell

Headaches can be a nuisance or, less often, a sign of serious illness. Knowing the facts about headaches can help you to help your teen feel better. It's important to track your teen's headache frequency and severity and attempt to narrow down any triggers that may be causing them. Sometimes a simple lifestyle change can improve the situation. However, it's important to talk to your teen's doctor about recurring or chronic headaches as soon as possible to determine if there's a possible underlying cause.

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Article Sources

  • American Academy of Family Physicians. Teenagers and Headaches. FamilyDoctor.org. Updated December 6, 2017. https://familydoctor.org/teenagers-and-headaches/.

  • Andrasik F, Grazzi L, Sansone E, D'Amico D, Raggi A, Grignani E. Non-Pharmacological Approaches for Headaches in Young Age: An Updated Review. Frontiers in Neurology. November 27, 2018;9:1009. doi:10.3389/fneur.2018.01009.

  • Bonthius DJ, Hershey AD. Headache in Children: Approach to Evaluation and General Management Strategies. UpToDate. Updated November 1, 2018. https://www.uptodate.com/contents/headache-in-children-approach-to-evaluation-and-general-management-strategies.

  • Cincinnati Children's Hospital Medical Center. PedMIDAS Tool. https://www.cincinnatichildrens.org/service/h/headache-center/pedmidas.

  • Kliegman RM, Stanton B, St. Geme J, Schor NF. Nelson Textbook of Pediatrics. 20th ed. Philadelphia, PA: Elsevier, Inc.; 2016.