Pediatric migraine often goes undiagnosed and undertreated. 1 in 11 children experiences migraine attacks. Because of this, parents, teachers, nurses, and other school personnel need to be aware of migraine and the various ways that it may impact children. Migraine is stigmatized as “just a headache.” Therefore, many children get stigmatized by adults when migraine is not understood as the neurological disease that it is. There are many things parents and teachers can do at home or in school to help children living with migraine. “In many patients a multifaceted approach involving lifestyle changes, treatment of comorbid conditions, and pharmacological treatments are needed for optimal headache control.”
Talk to your Child’s Primary Care Physician
The first thing that should be done, is to believe what your child is telling you. Expressing feelings and understanding of pain is very difficult to articulate (especially when so young). Having an open conversation about migraine gives a direction of care. Many children are seen in their home or at school as complainers or trying to get out of tasks. Listen and believe your child! You are his or her advocate.
Next, speak with your child’s primary care physician to develop a pediatric migraine plan. A treatment plan should include a variety of ways to accommodate various symptoms, triggers, and workload management. Keep detailed records. If there’s a day when your child feels better, note what she did differently. If your child feels worse, what changed? Migraine education needs to be addressed with parents, children, and the school to better understand the needs of each individual.
Create a Routine that Works
The pediatric migraine brain tends to work best with routine. There are many things you can monitor and keep consistent that may help. Set reminders to help your child stick to routines.
Wake and rise at the same time every day. Teens need 8-10 hours and preteens need 9-12 hours of sleep a night. Report snoring or difficulty breathing to the physician. Avoid screen time 30 minutes before bedtime.
Healthy Eating Habits and Drinking.
No skipping meals and identify trigger foods. Track food sensitivities. Eat clean foods without additives or chemicals. Drink lots of water and avoid sugary drinks.
Daily Movement, Relaxation and Fun
Exercise has been proven to help but also can trigger a migraine attack. Find ways to move the body that relieve stress and tension. Practice positive coping strategies such as BioFeedback or Cognitive Behavioral Therapy. Don’t overschedule and allow downtime. Recognize the positive and lean into fun activities that promote good times and gratitude.
It is helpful if schools are supportive of healthy habits that might impact your child’s wellness. There are many accommodations that can be made with teamwork and open informative conversations.
Pediatric Migraine Trigger and Symptom Management
There are many ways to help accommodate and manage migraine triggers in school and at home. Allowing the child to carry a bottle of water during the school day is an easy way to avoid dehydration. Families can access school menus to check for food triggers. Meals can be sent from home if needed and additional snacks may be needed throughout the day. The child should be excused to the nurse’s office at the first sign of attack or aura. A quiet place and a period of time to rest after taking migraine medication may be necessary. Teachers and staff should inform parents if the student is falling asleep in class or seeming fatigued. Parents should do the same.
Creating an Individualized Health Plan or 504 Plan can help put strategies into place. “Professional school nurses are leaders in the provision of special healthcare services. Through coordination of care among the school and the home, primary and specialty medical care, and clinics, school nurses ensure continuity of care across settings and minimize the risk for miscommunication.”
“Migraine-type photophobia, most commonly described as exacerbation of headache by light, affects nearly 90% of the patients. It is the most bothersome symptom accompanying an attack.” Managing light sensitivity in the classroom and at home may help avoid a migraine attack. Screen brightness can be adjusted or anti-glare screen filters can be added to screens.
Due to the Covid-19 situation, screen time has increased. Schedule built-in screen breaks to decrease strain on the eyes and use good posture to avoid muscle strain. Paper copies of assignments or notes can be requested. Additionally, masks may trigger a migraine attack after long use. Find a mask that fits comfortably and take breaks when it’s safe to do so.
Use of glasses like Axon Optics offer advanced, non-invasive light-filtering technology that’s been shown to reduce migraine symptoms. Using a test called HIT-6 (Headache impact test) Axon surveyed over 1,000 users both before and after wearing their glasses for 4 weeks. 85% saw a decrease in headache impact over the study. Additionally, participants were asked about their number of migraine days before and after they test and a 33% decrease in the number of headache days was reported.
“As a teacher and mother of two remote learning children, we all wear Axon Optics. My daughter was noticing headaches once remote school started and I gave her Axon Optics indoor glasses for her to use. She immediately found a decrease in headache days and notices when she is not wearing them. It was a natural and simple way to combat light sensitivity and screen time.”
A child who experiences significant phonophobia (sensitivity to noise) might need to be excused from noisy or loud situations during a migraine attack. Headphones can be provided during stressful times and volume of assemblies, parties and other noisy times may need to be addressed.
Classrooms should be fragrance free zones. Teachers should be aware that perfume and other smells are triggering and symptoms of migraine. If smells are bothersome at lunch or during school hours, the child may need breaks or a different placement to avoid fumes.
“Chronic migraine is a critical factor for perceived stress. Perceived stress affects quality of life of migraine patients.” School counselors and psychologists should be involved to offer help. Feelings of isolation due to migraine can cause or may lead to depression or anxiety. To help alleviate this, students may need breaks during testing or modified timelines for completing homework. If absences are prevalent, a modified schedule may be necessary.
Physical Activity is important yet a tricky piece of migraine management. Physical activity can trigger or help. Physical education alternatives like walking, yoga or stretching should be in place if migraine is present. Roller bookbags versus traditional ones may be needed to avoid excess weight and strain on the neck and shoulders.
Overall, pediatric migraine is something that needs to be addressed both in school and at home. There are many accommodations that can be made while communication is crucial. Consistency at home and at school is key in helping decrease or avoid triggers and manage symptoms. Many things can be done and nothing will work the same for everyone. Each child is different and deserves individualized attention.
Sarah writes the popular blog My Migraine Life about managing life with migraine. She works with many migraine organizations and advocates across the country to work towards a more migraine friendly world.