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 healthcare provider.

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.

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 (occurs in 85% of children and adolescents) and migraine with aura (occurs in 15% to 30%).

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 vomitingThrobbing or pulsating head painSensitivity 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 headStomach painThe head pain gets worse with activityAura (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.

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 headacheA headache that feels like the “worst headache” your teen has ever hadUnusual clumsiness or difficulty walkingProblems thinking, seeing, or speakingHeadaches or vomiting upon awakening in the morningStiff or painful neckFever

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 practitioner 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 healthcare provider 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 practitioner 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 healthcare provider will likely appreciate the extra help at his or her next appointment.

If your practitioner 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 healthcare provider 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.

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 healthcare provider 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:

AcupunctureMindfulnessCognitive-behavioral therapy (CBT)Transcranial magnetic stimulation (TMS)Progressive muscle relaxationDeep breathingMeditationMassage

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.

Lifestyle

Stress, depression, and anxiety have been linked with headaches in teens. Encouraging your teen to adopt healthy lifestyle habits that safeguard their mental and physical health can help reduce or prevent headaches and migraines, including:

Getting adequate sleep every nightExercising regularlyEating a healthy, well-balanced diet that includes plenty of vegetables, fruits, and whole grainsManaging stress by learning relaxation techniques, stretches, and healthy ways to copeTaking 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 sleepStressCertain foods like chocolate, red wine, citrus fruit, dairy, beans, nuts, and fatty foodsFood 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 creamToo much caffeine or caffeine withdrawalAlcohol or alcohol withdrawal (hangover)Environmental changes like bright, glaring, or flickering lights, strong odors, or changes in weatherNot eating enough food or not drinking enough fluidsSmokingChanges in regular scheduleHormones (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 healthcare provider 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 healthcare provider about recurring or chronic headaches as soon as possible to determine if there’s a possible underlying cause.