Plenty of teenagers will tell you that nearly everything about adolescence is a headache. But what many of them and their parents don’t know is that headaches themselves may suggest that the teenager should see a doctor.

The most important thing to understand about adolescent headaches is the same for adult headaches — that is, usually they’re nothing to worry about. But in some cases headaches can mean more serious conditions requiring a doctor’s attention. Understanding the difference between types of headaches can help you determine whether or not you should seek medical attention.

Anatomy of a Teen Headache

For starters, “headache” is something of a misnomer. It’s really how we perceive what’s going on in the nerves, blood vessels, and muscles of the neck and shoulders, rather than the brain itself (which can feel no pain), that determines whether we have a headache or not. Like adults, virtually all teenagers get headaches, with as many as 75 percent of teens reporting at least one headache a month.

According to Charles J. Wibbelsman, M.D., FAAP, Chief of the Teenage Clinic at Kaiser Permanente in San Francisco, “The most common adolescent headaches are tension headaches, specifically related to stresses in their lives — school, exams, sports, and extracurricular activities.”

The discomfort of tension headaches, Wibbelsman points out, are generally felt as the familiar “band around the head” sort of pain, as well as the back of the neck and upper shoulders. “Many tension headaches go away in the summer, when school’s out,” Wibbelsman says with a laugh.

The causes of tension headaches can often be traced to equally common (if unfortunate) teenage experiences and habits:

• Staying up too late and not getting enough sleep
• Overexertion or overexposure to the sun
• Stress at home or school (exam time is a prime time for teenage headaches)
• Dehydration or lack of proper nutrition
• Tobacco, alcohol, or caffeine (including caffeinated soft drinks)
• Loud music
• Excessive “screen time” (TV, video games, and the Internet)

Tension headaches that occur once a month or so (or when there are obvious outside factors such as “all-nighters” studying for exams) are not cause for excessive concern. You can help by encouraging your teenager to change the habits that contributed to the headache in the first place.

Additionally, most common tension headaches will go away after a fairly brief period of time, as a result of rest and, if necessary, using over-the-counter medicines, such as acetaminophen or ibuprofen. Avoid aspirin — children or adolescents should not take it. In rare cases, aspirin can cause Reye Syndrome, a serious and potentially fatal condition.

When It’s More Serious

Frequent headaches — even if they’re mild — could indicate a deeper problem. If they continue, you should take your teen to your pediatrician. If your teenager is having headaches a couple of times a week, or waking up with a headache, you need to see your pediatrician.

Less common and more serious are migraine headaches. These are far more painful and last far longer — from a couple of hours to a couple of days — than tension headaches. In addition to being more intense, the pain of a migraine headache often is located on one side of the head, rather than the milder, all-over discomfort of a tension headache.

“It’s important to get a correct diagnosis of migraine headaches,” Dr. Wibbelsman points out. “It’s important as well to be aware that migraines do run in families.”

Additional indications of a migraine headache include:

• Nausea or vomiting
• Extreme sensitivity to light
• Throbbing pain that’s different from the more even pain of a tension headache
• Pain that grows worse with exercise
• Headache that does not diminish with time
• Headache that does not respond to over-the-counter medicines
• History of migraines among other family members (migraines can be hereditary)

If your child has any of these symptoms, let your pediatrician know. She will examine the teenager and determine whether or not migraine headaches are the problem. While there is no cure for migraine headaches, they can be managed through a combination of prescription medicines and lifestyle changes. Your pediatrician will explain a migraine treatment plan to you and your child.

One increasingly common migraine trigger is an activity familiar to many teenagers. “We know more and more about migraine triggers,” Doctor Wibbelsman notes, “and among those triggers are flashing lights and loud sounds — the sorts of lights and sounds that accompany video games.”

Teen Headaches and Emotional Issues

A third and rarer type of headache is the psychogenic headache, which has some of the same symptoms as a tension headache but is caused by emotional problems, such as depression. Parents concerned about frequent teenage headaches should be alert for the signs of depression and other emotional disorders, including:

• Changes in eating habits, including loss of appetite
• Excessive moodiness or disinterest in typical activities
• Changes in sleeping habits
• Difficulty concentrating
• Declining school performance

Any of these symptoms — whether or not accompanied by headaches — should spur you to talk with your teenager and determine if depression or other emotional concerns are an issue. Naturally, a visit to the pediatrician is in order if your feel your concerns are justified. Your pediatrician will be able to determine if your child should see a therapist or other specialist in children’s emotional problems.

Other Causes of Head Pain

There are circumstances and conditions that can cause head pain and should always be examined by a doctor immediately. These include headache with:

• Any head injury whether or not the teenager loses consciousness; even a loss of consciousness for a few seconds indicates a concussion
• Seizures and convulsions
• Recurrent vomiting
• Dizziness and impaired balance
• Difficulties with vision that accompany a headache

In such cases the headache and related symptoms may mean concussion or other serious result of a head injury; nervous system or neurological (brain and central nervous system) conditions; or problems that require further tests and the medical attention of specialists.

Most headaches, of course, are unrelated to injuries, and most do not indicate more serious problems. Making that determination, though, is a  doctor’s responsibility. “Proper medical evaluation of headaches is crucial,” says Dr. Wibbelsman, who serves on the AAP’s Committee on Adolescence. “The pediatrician will be able to evaluate the nature of the headache and determine the proper treatment.”

He notes as well that the majority of adolescent headaches are just that — just headaches. “Parents should know,” he says, “that headaches are a normal part of adolescence, as they are a normal part of adulthood.”

If any type of headache occurs more than once a week, persists throughout the day, or is accompanied by any of the symptoms discussed in this article, take your teen to the pediatrician. That’s the best way to be sure that your adolescent’s headache won’t weigh too heavily on your head.

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By one estimate, 1 in 25 adults and almost as many teenagers have at least as many days with headaches as without them. Many veterans of chronic headaches know exactly what will trigger the pain or make it more likely to happen, and take precautionary steps. They may avoid certain foods. They may take up yoga to offset stress at work. If sensitive to strong odors, they may ask friends and family to go light on perfume. Now researchers are learning that overall health is critical, too.

A study published today in Neurology links headaches with unhealthy lifestyle in teens, a group for which little data exists. Researchers in Norway looked at the relationship between three factors—smoking, weighing too much, and exercising too little—in adolescents ages 13 to 18. They found that any of those factors increased the likelihood of frequent headaches (by about 30 percent). Teens who fit all three categories were more than three times as likely as teens with no factors to be candidates for frequent headaches. There’s no reason to think the results would not apply to adults. So both adults and adolescents can find headache relief by:

Exercising more. Thirty minutes of walking, biking, or other moderate physical activity at least three times a week is good for managing headaches, says Richard Lipton, a neurologist at Montefiore Medical Center in New York. Exactly how exercise helps isn’t clear, he says. It may reduce stress, a recognized cause of headaches. Following treadmill and other aerobic workouts, participants in a small Turkish study reported fewer and milder migraines, which researchers think was due to the rise in pain-fighting endorphins from the exercise. Getting fit, moreover, improves well-being and staves off other chronic conditions, including diabetes and cardiovascular disease, which research has also linked to headache.

Losing weight. A 2006 study by Lipton and colleagues found that about 4 percent of healthy-weight participants reported frequent migraines—defined as 10 to 14 days per month—compared to 5.8 percent of overweight, 13.6 percent of obese, and 20.7 percent of morbidly obese subjects (those above a normal weight with a BMI of up to 30, 35, and higher respectively). As participants’ BMI increased, the proportion reporting severe headache pain also went up. Shedding pounds appears to help reduce headaches in sufferers who are overweight, says Lipton. Early evidence shows that obese people who undergo bariatric surgery have fewer headaches after they lose weight, he says. How much weight loss makes a difference? That question is a little ahead of what research tells us, says Lipton.

Adjusting sleep. As little as one hour more or less than usual could bring on a headache. The standard recommendation is eight hours, and experts say headache sufferers could benefit from sticking to that. One study of women with migraines found that after adjusting to meet the eight-hour benchmark, participants had migraines less often and those they experienced were more tolerable.

Modifying diet. Certain foods seem to trigger headaches in some people. Alcohol and chocolate are candidates, but a likelier culprit is coffee—even though caffeine helps relieve headache pain (it is an ingredient in several prescription headache meds). It can get you from both ends: A study published in July in the journal Headache found that adolescents who guzzle one or more cup per day boosted their chance of a migraine, while studies show that quitting a coffee habit can produce withdrawal headaches in adults. Modifying diet seems more effective in adolescents than adults, says Lipton, but that may be because adults who have long suffered migraines have figured out on their own what trigger foods to avoid such as red wine and certain aged cheeses. Experts recommend recording food and other triggers in a headache diary.