Monday Is the Worst Day for Teens With Migraines

From the WebMD Archives

July 6, 2000 (Montreal) -- Although you might be tempted to file this one in the "well, duh!" category, stick with us: Teen-agers suffer from migraine headaches most often on Mondays and least often on Saturdays and holidays, say neurologists who surveyed patterns of migraine in adolescents. They reported their results at a meeting of headache researchers here.

Migraines are disabling conditions characterized by throbbing pain, usually on one side of the head, and often accompanied by nausea and vomiting and by extreme sensitivity to light and/or sound.

In a study of more than 1,900 teens diagnosed with migraine, researchers found that adolescents between the ages of 12 and 17 suffered migraine attacks most frequently on Mondays, with 20% of the teens reporting attacks on that day. The numbers remained high on Tuesdays and Wednesdays, at 16% both days, with the frequency of attack beginning to slack off as the end of the week approached, and bottoming out at 9% on Saturdays.

The spike in migraines early in the week appears to be related to stress and not, as some might imagine, to malingering, lead researcher Paul Winner, DO, director of the Palm Beach Headache Center in West Palm Beach, Fla., tells WebMD.

"In that data base, 88% of these adolescents described having pain with activity," Winner says. "That's not something you would ... know to tell the doctor. ... That tells you that you're not going to play Nintendo, you're not going to go up the stairs, you're not going to go out and play basketball.

"The other thing that adolescents don't know to tell us is they have photophobia or phonophobia [sensitivity to light or sound] ... but 80% of kids in the study did. There are doctors in the country that don't necessarily know that's part of certain headache patterns."

According to the American Headache Society, headaches are common among children and adolescents, with migraines affecting 3% of children at age 7 and 4-11% of kids between the ages of 7 and 15. Yet despite the frequency of severe headaches in this population, surprisingly little was known about how teens suffer from migraines, Winner tells WebMD.

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"There has never been a study like this, a large study that has looked at adolescents and asked what their headaches are like, because there are differences between younger children, adolescents, and adults," he says.

Although headache researchers had generally thought that nausea and vomiting would be as common among adolescents as adults, they found that only 60% of teens suffer nausea during a migraine attack, compared with more than 80% of adult sufferers.

"But there's still very high disability from migraines in adolescents," Winner says. "The duration of headache we know -- not from this study but from others -- is shorter in adolescents, but seemingly quite intense. If we could cut those headaches down to Saturday level or below, that would be a big plus."

The solution could be as simple as changing sleep patterns, or working with teens to figure out how to reduce the stressors that may trigger migraine attacks. In addition to over-the-counter drugs such as aspirin, Advil and Tylenol, and prescription medications designed for migraine sufferers, many teens with migraines may get relief from non-medical therapies aimed at reducing the effects of stress, such as biofeedback and relaxation training, study co-author A. David Rothner, MD, director of the pediatric headache center at the Cleveland Clinic Foundation, tells WebMD.

Timing of treatment is also important, Winner emphasizes. "We also know from the study that 72% of all headaches occur during the daytime, between 6 a.m. and 6 p.m., in adolescents, and we also know they take a long time to treat their headaches: almost two hours. If they know they have migraine ... we can instruct them, especially on Monday, Tuesday, and Wednesday, [to] treat that headache early, because it's going to get out of control."

Treating teens isn't always easy, one expert says. "They're a difficult bunch to deal with, because they have all sorts of teenage behaviors and issues," says Allan L. Bernstein, MD, director of the headache clinic for Kaiser Permanente Health System in Santa Rosa, Calif., who was not involved in the study. "In spite of the old theory that people with migraines shouldn't drink alcohol, teenagers do."

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But when it comes to treatment, teens are pretty good at taking their medications, Bernstein tells WebMD. "At least in migraine, since you're treating an acute event, they're pretty good at taking their medicine. When they're really hurting, they're good at taking their pills."

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