Ask Dr. Marla: When do you know if your child’s headache is something serious?

My 13-year-old son sometimes complains of headaches. Could they be linked to hormonal changes? When is it OK to treat the headaches with pain relief and when should I take him to see a doctor?

The first step is to make sure we have the right diagnosis. Your question refers to the headaches as being occasional. We always recommend a review with a complete physical done by your doctor. When we see a teen with headache there are a number of questions to ask.

• How frequent and severe are these headaches?

• Are there any associated symptoms such as nausea, sensitivity to light or noise, or vomiting?

• Are the headaches severe enough to interfere with your child going to school or performing at school?

• Are there any other associated illnesses that your child has?

You ask whether hormones or puberty can play a role. That really is a question about what triggers these headaches. To answer that question, it is helpful to keep a headache diary. Tracking when the headaches happen will help you identify whether or not there are any triggers. The most common triggers of migraine headaches are foods such as chocolate, cheese, processed meats and foods with preservatives. For some, fried food or caffeine can be a trigger. We can see headaches fluctuate with hormones and menstrual cycles in girls. Headaches can worsen as boys reach adolescence.

Typically more boys than girls get headaches before puberty. Take a look at your child’s lifestyle. A regular sleep routine is important, with at least eight to 10 hours of sleep. Having a sleep routine is helpful in avoiding those identified triggers. Encourage your child to have regular meals, including breakfast. Hydration is really important as well. In this age group we encourage adolescents to drink about two litres of non-caffeinated drink each day. Water is truly ideal. That amount should be increased during exercise or warmer weather.

Being active is also a great way to avoid headaches. Be active with your child, ideally every day for at least 30 minutes. It also is important to have realistic goals about treatment. We want to avoid over medication but at the same time the goal is to reduce the number of headaches as well as how severe they might be.

See your doctor to decide on a treatment plan for the headaches. Establish when it is reasonable to treat and what you should be treating with. Common medication choices include acetaminophen, ibuprofen or naproxen. It is important that your child understand how to manage his headaches. If medications are being used, he should clearly understand the dosage and names of the medications and only take medications under supervision.