Our own experience with headaches reassures us that the pain will disappear in time, is not caused by serious disease, and is treatable with over the counter medications. What worries us is the teen whose headache is so frequent or so severe that their daily activities seem to be affected. And then there is a silent fear that the real cause of a teen's headache is a brain tumor.

In order to help determine the reason for a headache, pediatric neurologist Dr. David Rothner of the Cleveland Clinic has classified them into four groups: The first represents the teen with a sudden, first time headache, usually seen with infections, such as sinusitis, sore throats, or the flu. The second would be headaches that suddenly flare up, last less than a day, and then go away only to reoccur weeks later without changing in severity. These headaches usually represent migraine. Dr. Rothner’s third group is the chronic headache which occurs every day to once a week, each headache as painful as the one before, never any better or any worse. Otherwise healthy, these people suffer muscle contraction headaches. Headaches that begin over a short time and become increasingly worse in both frequency and intensity represent the fourth group. These people will have other neurological symptoms and need evaluation to rule out serious brain disease.

Evaluating the teen with headache is much like detective work, and you can supply valuable clues by keeping a record of the following information: How long has the headache been present? Are they getting worse or staying the same? How often do they occur? How long do they last? What brings them on (food, heat, riding in the car, exercise, etc.)? Where is the pain? What does it feel like? Does the headache make them go to bed? Do they have nausea or vomiting? Does the headache occur at any particular time of day? Is there a warning before the headache strikes? What makes the headache better? What makes it worse? Any family history of headaches? Frequently a good history can make an accurate diagnosis for the physician, thereby eliminating the need for expensive laboratory tests, x-rays, brain scans, and hospitalization.

Many go to the eye physician before their pediatrician to find the cause of their head pain. Visual problems and eyestrain are rarely an adequate explanation for headaches and correcting any refractive errors does not stop the recurrent head pain.

Migraine is the most common cause of recurrent headache. These headaches usually begin during the early school years and there is frequently a history of migraine in immediate family members. The pain is often reported as throbbing or pounding in nature restricted at times to one side of the head. Migraine occurs several times a week or as infrequently as twice a year. An aura occasionally begins a migraine headache in which the sufferer sees spots (visual "fireworks"), complains of abdominal pain, or gets cranky and appears pale. During the attack they may experience nausea, vomiting and abdominal pain. The person wants to be left alone and usually voluntarily goes into their bedroom, closes the blinds to make the room dark, and falls asleep. On waking, they feel better, although a dull headache pain may last for days. On examination these people have no abnormal findings.

Muscle contraction or tension headaches usually begin between ages 8 to 12 years and are more common in girls. The non-throbbing pain is usually localized to the back of the skull but can be felt over the forehead. Usually the pain lasts most of the day, remaining constant or gradually increasing in severity. There is no warning period like in migraine, but tension headaches can be associated with vomiting. These people are healthy and have a normal neurological examination.

You must walk a fine line in dealing with this type of headache because some use the problem as an escape from responsibility or as a way of getting attention. The pain is real and must be treated with respect, you should learn how to cope so that the headache does not disrupt your life. You must go to school and arrange with the school to receive medication as prescribed. At home, minimize the attention given the headache.

Headaches caused by brain tumors and other serious medical problems occur at any age. The pain usually progresses in frequency and severity over a short time. Thus, headaches of recent onset (two to three weeks) are worrisome while headaches of more than three month’s rarely are serious. A headache caused by an intracranial problem is made worse by sneezing, coughing, or straining, usually comes on without warning, and may wake you at night. "Serious" headaches are made worse by body movements (especially bending forward) and are relieved by a change in position. For example, when the headache occurs in the early morning, it is relieved by getting out of bed. You should also watch out for coordination problems, blurred vision, one sided muscle weakness, speech impairment, seizures, or minor intellectual or behavioral changes. The neurological examination is almost always abnormal.

Fortunately, the overwhelming majority of headaches are transitory and bearable. In most cases, time heals the discomfort. Your physician should be consulted, however, since a correct diagnosis is essential to determine the best treatment.