Dear Dr. Donohue — Our 16-year-old daughter has been battling daily headaches for the past 18 months. She says the pain is at her temples and across her forehead, and the pain level is six out of 10 on a pain scale. A neurologist, an ear, nose and throat doctor, a chiropractor, a pediatrician, an orthodontist and a dentist cannot find a reason for the pain. She has been on numerous medicines, including migraine medicines, and has stopped using them because of their ineffectiveness and side effects. Biofeedback was not helpful. Her neurologist prescribed a new medicine. If she were your daughter, where would you look for a solution?



More than 300 causes of headaches exist, but, for most, the kinds of headache can be reduced to four or five causes: migraine, cluster, tension, induced by physical exertion and medicine overuse.

Tension headaches — the most common kind, and the kind that more or less fits your daughter's description — are felt on both sides of the head. People describe the pain as a squeezing, tight band. Any part of the head, including the back of the neck, can be involved. Stress and lack of sleep often bring them on, but frequently, no cause is found. Activity, like walking up and down stairs, doesn't make the pain worse, as it does with other headaches. Tension headaches may make people sensitive to light or sound, but not to both. Standard medicines like Tylenol, aspirin and anti-inflammatory drugs regularly bring relief, but I don't want to suggest medicines for your daughter. She has had plenty.

Overuse of headache medicines often can lead to daily headaches, which stop only when medicines are stopped. I know your daughter put an end to her medicine-taking for a while, but did she do so long enough? It can take two weeks to get over the medicines. Some have to be tapered. This is something to consider.

What would I do if this young lady were my daughter? I'd take her to a large medical center, like the medical school of your state. She is seeing a competent neurologist, but at a large center, a team of neurologists can put their heads together and come up with a new diagnosis and new treatment plan. Has your daughter had any imaging tests, like brain scans? I'm sure she has, but I want to mention them to anticipate reader curiosity.

The headache booklet details the problems of the more common headaches and their treatments. To order a copy, write: Dr. Donohue — No. 901, Box 536475, Orlando, Fla. 32853-6475. Enclose a check or money order for $4.75 with the recipient's printed name and address. Please allow four weeks for delivery.

Write Dr. Donohue at P.O. Box 536475,

Orlando, Fla. 32853-6475.