Complaints of headache, stomach ache, back pain and morning fatigue are common among United States adolescent girls, according to an article in the August issue of The Archives of Pediatrics & Adolescent Medicine, a theme issue on mental health and one of the JAMA/Archives journals.

According to information in the article, symptoms such as these are commonly reported among children and adolescents, and girls are at a greater risk of having more than one of these symptoms at the same time. Chronic pain may have long-term effects and negatively affect school attendance, relationships and developmental experiences, the article states.

Reem M. Ghandour, M.P.A., of the Health Resources and Services Administration (HERSA), Rockville, Md., and colleagues investigated the prevalence, frequency and co-occurrence of headache, stomachache, backache and morning fatigue among a nationally representative sample of 8,250 girls in grades six through ten between 1997 and 1998 (representing the 10,360,601 girls nationwide in grades six through ten).

The researchers found that "Among U.S. adolescent girls, 29.1 percent experience headaches, 20.7 percent report stomachaches, 23.6 percent experience back pain, and 30.6 percent report morning fatigue at the rate of more than once a week," and that co-occurrence of more than one the symptoms is common.

The researchers also found that among girls who experienced headaches more than once a week, 53.3 percent also reported stomach pain more than once a week, and 74.3 percent reported morning fatigue more than once a week. Alcohol use, caffeine intake and smoking were strongly associated with all symptoms, while parent and teacher support appeared to protect girls from these symptoms.

"Somatic complaints of headache, stomachache, backache, and morning fatigue are common among U.S. adolescent girls," the authors write. "These findings suggest that effective clinical treatment may require comprehensive assessment of all female adolescents presenting with seemingly isolated somatic complaints to accurately identify and treat both the presenting symptom and any related conditions."

"While linkages may be drawn between selected complaints and other biological functions such as menstruation, most of these complaints seem to be associated more strongly with social, environmental, and behavioral risk factors such as perceived social support and alcohol and caffeine consumption," the researchers conclude.