Tension-type and migraine are the two most common kinds of headaches. Migraines can be triggered by a variety of factors, including fatigue, hunger, emotional stress, or a change in caffeine consumption. Teenager Jonathan Gray suffers from migraines.

All of us get headaches once in a while. But for 1 in 10 people, the affliction is serious. What causes the worst headaches and how can you prevent them?

Eighteen-year-old Jonathan Gray has had severe migraine headaches for more than five years — since the seventh grade and they've nearly ruined his life. "I get them about four times a week, usually in the mornings," he says. The headaches can last anywhere from two hours to two days. "I get nauseous. I can't be near light or noise, and one side of my head hurts so badly I can barely stand it," he says. "It's not like I can push past the pain — I'm totally unable to function." Jonathan missed so many school days last year, he had to go to summer school. And, instead of attending college next year as he planned, Jonathan is enrolled in more high school-level classes to improve his poor grades. Not everyone suffers from headaches as severe or debilitating as Jonathan's. But serious headaches, such as migraines, are more common in teens than ever before. According to the Journal of the American Medical Association, new research shows that 8 million children and adolescents between the ages of 6 and 17 report having frequent or severe headaches. Migraine headaches result in more than 1 million lost school days every year.

What causes headaches? Why do some people, like Jonathan, get more frequent and more severe headaches than others? And what can you do to prevent those throbbing achy episodes? Tension vs. migraine. There are many different kinds of headaches, but the two most common are tension-type and migraine. Tension-type headaches are usually characterized by a steady, dull pain in the forehead, back of the neck, or both sides of the head. About 90 percent of people get these headaches. Jessica Gould is one of them.

"The ache started behind my eyes and temples, and then moved around the sides of my head," says the 17-year-old from Upper Saddle River, New Jersey. Last year, Jessica was plagued by daily headaches. "I was overly stressed-out about grades," she says. "My classes were harder and there was a lot of homework. I'd come home from school with a really bad headache."

Tension-type headaches, such as Jessica's, are rarely incapacitating, but can be a chronic annoyance.

Unlike tension-type headaches, migraines are characterized by intense, throbbing pain, usually on one side of the head, often accompanied by nausea and a heightened sensitivity to light and noise.

"In some forms of migraine spots before the eyes or other brain symptoms occur before the headache," says Dr. Seymour Solomon, a professor of neurology and headache expert at Albert Einstein College of Medicine in the Bronx, New York. Other symptoms may include a dizzy feeling or seeing a pattern of blinking lights. These symptoms are called an "aura." Migraine headaches can last a few hours or a few days; they can occur only occasionally or several times a week. Migraine sufferers, like Jonathan, often must stay in bed for the duration of the headache. "It's frustrating,"Jonathan says, "because migraines force me to miss out on so many things. I miss parties and hanging out with friends, and I've practically had to give up playing soccer — the sport I love most of all."

To make matters worse, it can be difficult for migraine sufferers to convince people that they're really ill. "Some of my teachers aren't very understanding," says Jonathan. "They don't give me extra time to finish my work. They think I'm faking. But I'm not faking. This is a terrible way to live."

What Hurts?

Even though it may feel like your skull is pounding, there are no painsensing nerve fibers in your bones. The pain is actually coming from a network of nerves that extends across your scalp. In addition, there are muscles in your head and blood vessels on the surface and base of the brain that contain pain-sensing nerve fibers. Once stimulated, these nerves send a message along the length of the nerve fibers up to nerve cells in the brain. The message is: ouch! Any of the same biochemical changes occur during tension-type and migraine headaches. In fact, some experts believe that tension-type headaches are simply a milder form of migraine. But what gets a headache started in the first place? Experts aren't sure. In the past, physical tension and emotional stress were often blamed. Many experts still believe that stress can cause or exacerbate headaches. But now, experts also believe that headaches-both migraine and tension-type-are biologically based, like diabetes, the flu, or other physical illnesses.

The Causes

The biological theory suggests that some people are genetically predisposed to getting headaches. Experts at the National Institute of Neurological Disorders and Stroke in Washington, D.C., hypothesize that these headache sufferers may carry fewer of the natural painkilling proteins, or endorphins, than most people.

Since migraines run in families (Jonathan's mother has suffered from migraine headaches, too), doctors speculate that some people inherit this glitch in brain chemistry, which makes them especially sensitive to "triggers" foods or situations which set off the chain of biochemical changes that lead to a headache. Migraine triggers vary from person to person, says Dr. Solomon. Among the most common: fatigue, too much or too little sleep, hunger, emotional stress, or a change in caffeine consumption. Certain foods can also set off a headache. Other triggers include environmental factors such as: temperature changes, humidity, bright or blinking lights, perfume, tobacco smoke, and loud noises. Many females with migraines have attacks linked to a certain point in their menstrual cycles.

Some of these same triggers can also set off a milder, tension-type headache. So if you skip meals, you could find yourself with an aching head at around 4 p.m. Or if you're a caffeine fiend and you skip a day, you might get a caffeine-withdrawal headache. And if you fall asleep face down in your history book at 3 a.m., you run the risk of waking up with a headache.


Fortunately, most people with occasional tension-type headaches can control them with care and common sense. There are many over-the-counter medications that can eliminate headache pain. These medicines all have different active ingredients, and some contain caffeine, so it's important to read and follow the directions on the package. Anyone taking prescription medications should check with a doctor before taking over-the-counter pills to avoid dangerous drug interactions. Researchers are working on new treatments, but there is still no cure for migraines. A doctor can advise behavioral changes or offer prescription medications that help many migraine sufferers lead more normal lives. Jonathan is on a strict regimen of preventative medication and biofeedback. He also injects himself with antimigraine medications when he feels an attack beginning. Several new prescription medications are available, and Jonathan is trying them, too.

Fortunately, not all migraine sufferers need to go to great lengths to control their pain. Sometimes, a small lifestyle change, such as avoiding caffeine and other foods that trigger headaches, can make a big difference. Relaxation techniques, as well as regular exercise, help many people.

Jonathan is hopeful. "I guess I've just had to adapt," he says. "I try not to think about my headaches and lead as normal a life as possible. There's new medication all the time, and who knows? Maybe someday soon I won't have headaches at all."