Across the country, school has resumed, and new research has confirmed what many parents have expected: Headaches increase with the start of the school year.

Physicians at Nationwide Children’s Hospital in Columbus, Ohio, attribute the increase to a wide range of factors, including increased stress, decreased sleep, poor hydration, and prolonged screen time.

Ann Pakalnis, MD, an attending neurologist and Director of the Comprehensive Headache Clinic at Nationwide Children’s, led the study, which evaluated 1,300 emergency department visits from 2010 through 2014. Results showed the number of headache visits stayed stable throughout the year, except for fall, when they increased by more than 31% in children ages 5 to 18 years old.

“Stress is a really significant player with children and teens’ headaches,” Dr. Pakalnis said in a video released by the hospital. “Parents report that all the time. We see that all the time, and school is the biggest stressor.”

Dr. Pakalnis noted that headaches in boys ages 5 to 9 are quite common, although they tend to improve once the boys enter adolescence. In girls, however, migraines often appear at puberty and continue throughout adulthood.

For headache and migraine prevention, study leaders recommend paying attention to lifestyle factors and advise children and adolescents to eat three meals a day, get 10 hours of sleep at night, drink enough liquids, while avoiding caffeine and sports drinks, and remove stress when possible. Over-the-counter medications such as acetaminophen, ibuprofen, or naproxen can be helpful, but they should be used cautiously, as they can make headaches worse if used too often.

Howard Jacobs, MD, a headache specialist at Nationwide Children’s, provided advice for parents wondering if a trip to the physician is warranted.

“A sudden, severe headache or a change in the headache sensation from previous, what we call ‘first or worst’ headaches should be evaluated,” he said. “Another good rule of thumb is that if the headaches are interfering with a child’s normal routine, then it is time to get them evaluated, so therapy can be instituted to return your child’s life to normal.”