I just read an interesting study about teenagers with headaches. About one to two percent of adolescents have chronic daily headaches, defined as greater than 15 headache days per month for greater than three months.
Once school begins, teens stress levels increase with each week of school, and with that come more complaints of chronic headaches. It is not unusual for me to see several teens a week who complain that they have headaches every day. Despite these persistent headaches, the majority of adolescents continue to participate in their school activities, sleep well once they fall asleep and spend their weekends doing whatever it is that teens all do.
I see very few teens who look like they are in “severe” pain, although they state that their head is “killing” them while they chatter away about where it hurts, and how often it hurts etc. It is quite reassuring to watch their faces and expressions as they go into detail about their headaches. In these cases it is important to obtain a good history to rule out any underlying pathology, as well as to inquire about family history of migraines.
In this study the authors followed adolescents ages 12 – 14 years who met criteria for chronic daily headaches. They followed the group after both one and two years, and then again after eight years. The results showed that after one year 40 percent of adolescents still complained of chronic headaches. After two years, only 25 percent reported headaches.
After eight years, only 12 percent reported chronic headaches. Most participants reported substantial or some improvement in headache intensity and frequency during the eight-year follow-up.
The most significant predictor for ongoing problems with headaches was onset of chronic headaches before the age of 13 years. For the most part 75 percent of adolescents with chronic daily headaches improved over the eight-year period, which is quite reassuring.
This study just seemed to confirm that teens and headaches go together. If a good history and physical exam is performed and there seem to be no underlying problems that contribute to their headaches, it is best to discuss the natural history of chronic headaches.
I think it is important to spend time with adolescents to explore ways to alleviate stress as a trigger for chronic daily headaches. Basic changes in lifestyle such as healthy eating, regular exercise, and a good night’s sleep will often help reduce headaches. Relaxation techniques and cognitive behavioral therapy may also be utilized. At least we know that the headaches reduce with time, maybe just a maturational process, like many things!
That’s your daily dose, we’ll chat again tomorrow.