Headaches in Teens

What's Normal and What's Not

teen girl with headache at school
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Headaches in teens are a common problem. By the time your teen is 15 years old, he has probably had at least one headache. Sometimes headaches are just a pain, but sometimes they can mean that something more serious is happening.

Headache Basics

Not every headache is caused by the same problem in the body. There are many proposed causes of headaches. There are primary headaches, like migraines or tension-type headaches.

The causes of these headaches are controversial and are still being studied. From dysfunction of the neurons in the brain to changes in the blood vessels supplying the brain with blood, there are thought to be many causes of primary headaches.

Secondary headaches are ones that happen secondary to another issue in the body. These headaches can be caused by space-occupying lesions in the brain such as brain tumor, increased pressure in the head, or abscess. Other causes include drug intoxications, sinus disease, meningitis, high blood pressure, or stroke. These headaches happen much less frequently than primary headaches.

Headache Patterns

If your teen has headaches or has just gotten his first one, it's helpful to know how to start to classify a headache. It can help a parent determine if it is a headache that needs immediate attention or not. It can also help when discussing a headache with a healthcare provider.

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

  • An acute headache: This is the first headache that someone has. It eventually resolves, with our without treatment.
  • Acute recurrent headache: If an acute headache is the first, acute recurrent is when that first headache goes away completely but returns at some point in the future. That second one resolves completely, and the pattern continues.
  • Chronic daily (nonprogressive) headache: This is a headache that tends to be constant, or happens most days. This headache does not 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. This is one of the most concerning kinds of headaches, and the teen should see the pediatrician right away if this kind of a headache is happening.

But Is It A Migraine?

Parents and their teens are often afraid that they have migraines. Part of the problem is people think migraines are horrible and unmanageable. Although they can be unpleasant and disruptive to someone's life, they don't have to be debilitating.

Migraines are acute recurrent headaches. During these headaches, there must be at least three of the following symptoms or associated issues: stomach pain, nausea or vomiting, throbbing head pain, pain on one side of the head, aura (visual, sensory, or motor), headache gets better after sleeping, or there is a family history of a migraine. An aura is a symptom or a few symptoms that occur right before a migraine. An aura 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.

It isn't necessary for a headache to be only one-sided in children or teens, but it is part of the criteria for adults.

This is a quick summary of when a headache might be a migraine, but it is helpful for parents to have an idea of whether or not a headache is truly a migraine. If your child doesn't have any of the other symptoms that usually come with a migraine, it probably isn't one. If the other symptoms sound familiar, talk to your pediatrician or family provider about your concerns.

Treating a Headache

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 the environment.

These are some common headache triggers:

  • Not enough sleep.
  • Stress.
  • Certain foods like chocolate, red wine, citrus fruit, dairy, beans, nuts, and fatty foods.
  • Food additives like MSG or monosodium glutamate (Chinese food or other processed foods), nitrates (hot dogs, luncheon meats), aspartame (sugar substitute), or tyramine (certain wines, aged cheeses, dried or pickled fish, yogurt, 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 or not drinking enough fluids.
  • Smoking.
  • Changes in a schedule.
  • Hormones. Many women find that they get headaches at certain points in their menstrual cycle.
  • Prescription medications.

If this list makes you or your teen think “Yes! That's it! That's the trigger,” then you have the answer. Avoid the trigger or triggers, and the headaches should go away or be greatly decreased. If you or your teen isn't sure, try doing a headache diary. A headache diary is a way for your teen to track the headaches and find out what things trigger them. Try the diary for a month or so. If a pattern emerges, then you can eliminate the trigger. Keep the diary longer if there is no clear pattern, or if you think the headaches are related to the menstrual cycle. Keep these diaries because your pediatrician or family healthcare provider may want to see them. These diaries can provide a lot of information. Another way to help your provider understand the headaches is by using the PedMIDAS scale. This short quiz can help you to explain to your provider how severe and/or debilitating the headaches are for your teen. Bring the PedMIDAS scale plus a headache diary - your doctor will thank you!

The other way to treat headaches is with analgesic (pain) medications. If your teen has never taken a pain medicine for a headache, you can try acetaminophen (Tylenol) or ibuprofen (Advil, Motrin). The recommended dose for your teen will be on the bottle, or 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 is harder to treat.

When To Worry

Headaches are painful and disruptive. They can sometimes be a sign of a serious problem. These are some signs that a headache is a problem:

  • Chronic and progressively worsening headache.

  • A headache that feels like the "worst headache” they've ever had.

  • Any unusual clumsiness or difficulty walking.

  • Any problems thinking, seeing or speaking.

  • Headaches or vomiting on awakening in the morning.

  • Stiff or painful neck.

    If your teen has any of the above symptoms, contact your pediatrician or family care provider immediately. If your provider cannot see your teen right away, or this bad 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 with your questions or concerns.

    Headaches can be a nuisance or a sign of serious illness. Knowing the facts about headaches can help you to help your teen feel better.


    Behrman, RE, Kliegman, RM, and Jenson, HB. Nelson Textbook of Pediatrics, 2004.

    Headaches in Children and Adolescents. American Academy of Family Physicians. February 22, 2009. http://www.aafp.org/afp/20020215/625.html

    Lewis, DW. Headaches in Children and Adolescents. Current Problems in Pediatric Adolescent Health Care, July 2007.

    Neinstein, LS. Adolescent Health Care: A Practical Guide, 2002.

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