Headache, stomachache, backache, and morning fatigue among adolescent girls in the United States: associations with behavioral, sociodemographic, and environmental factors

Arch Pediatr Adolesc Med. 2004 Aug;158(8):797-803. doi: 10.1001/archpedi.158.8.797.


Background: Data on the prevalence and co-occurrence of multiple somatic symptoms among US adolescent females as they are influenced by sociodemographic, behavioral, and environmental factors is limited.

Objectives: To describe the health status of adolescent US females measured by the prevalence, frequency, and co-occurrence of headache, stomachache, backache, and morning fatigue and to investigate associations between selected risk and protective factors.

Design, setting, and participants: School-based, cross-sectional, nationally representative survey of adolescents in the 6th through 10th grades in the US. Data collected between 1997 and 1998.

Main outcome measures: Prevalence of headache, stomachache, backache, and morning fatigue.

Results: Among US adolescent girls, 29.1% experience headaches, 20.7% report stomachaches, 23.6% experience back pain, and 30.6% report morning fatigue at the rate of more than once a week. Co-occurrence of somatic complaints is common. Among girls who experienced headaches more than once a week, 3.2 million (53.3%) also reported stomach pain more than once a week and 4.1 million (74.3%) reported morning fatigue more than once a week. Heavy alcohol use, high caffeine intake, and smoking cigarettes every day were strongly associated with all symptoms, while parent and teacher support served as protective factors.

Conclusions: Somatic complaints of headache, stomachache, backache, and morning fatigue are common among US adolescent girls and co-occur often. Effective clinical treatment of this population requires comprehensive assessment of all female adolescents presenting with seemingly isolated somatic complaints.

MeSH terms

  • Abdominal Pain / epidemiology*
  • Adolescent
  • Adolescent Behavior
  • Alcohol Drinking / epidemiology
  • Back Pain / epidemiology*
  • Caffeine
  • Comorbidity
  • Continental Population Groups / statistics & numerical data
  • Educational Status
  • Fatigue / epidemiology*
  • Female
  • Headache / epidemiology*
  • Health Status
  • Humans
  • Multivariate Analysis
  • Prevalence
  • Social Support
  • Stomach
  • Time Factors
  • United States / epidemiology
  • Violence / statistics & numerical data


  • Caffeine