Pediatric Migraine: A Primer for Teachers and School Nurses

Pediatric Migraine: A Primer for Teachers and School Nurses
By: Howard S. Jacobs, MD
 
Almost sixty percent of children complain of headache at some point. About eight percent of children suffer from migraines. That means that in the average classroom there will be one, possibly two migraine sufferers, so knowledge of the disease should prove to be very important.
 
Let's start with some definitions. A migraine is a severe headache that come and go, lasting from one hour as long as 3 days. Migraine often has associated symptoms that include: nausea or vomiting or  light sensitivity and sound sensitivity. A minority of children will have an aura (preceding symptom) before the onset of the migraine. Auras are classically thought to be visual, but can affect his speech or involve feelings of numbness in the face and arm.
 
Most people think of migraines as being one-sided and throbbing, but this is often not the case in children and teens, who may complain of a bilateral steady pain, often but not always, above the eyes.
 
Migraines are further classified as episodic (<15 per month) or chronic ( > 15 per month). Children who get more than one migraine per week will often be considered for placement on  a daily preventative medication. It is important to note that children with chronic migraines (days of severe headache interspersed with days of less severe pain) or those few students who suffer from headache pain every day may require additional treatment options.
 
How should you handle these students? 
 
Let's start with the episodic migraineur.  The most vital concept is that with migraines time is of the essence. Both migraine specific medicines and non-specific pain relievers work significantly better when taken at the initial inkling of pain. This is not the situation to say "Let's give this a little time and see how you feel in fifteen minutes". Allowing the child to get her/his medicine quickly and then have a short time to rest may be adequate to get the child well enough to return to class. If a student comes to the teacher and says she/he is experiencing an aura, they should get there migraine medicine immediately. Doing so promptly may successfully avert the headache. 
 
Chronic migraineurs pose a different problem. Many become somewhat acclimated to their discomfort and may seem as though they are not suffering despite describing significant pain levels. This can be quite frustrating to teachers and nurses, which in turn can become frustrating to the student who feels no one believes them. Our goal is to keep these children and teens in school to whatever extent possible and keep them involved with their peers. The isolation of not being with peers and not doing normal activities, only serves to promote the self image of illness. We often tell our patients that sometimes they have to act better before they can feel better. School accommodations are often the keystone in getting these children transitioned from homebound, to living a normal childhood or adolescent lifestyle.
 
How else can you help? 
 
Children with Migraines often have lifestyle issues that compound their problem.  As physicians we try to educate our patients to get more sleep, eat regularly, get exercise, stay well hydrated and deal with stress. Teachers often spend more time with our patients than anyone else. Keep them active. If the school provides breakfast or lunch, make sure the children are eating. Allow them to have a water bottle at their desk. If your student is appearing overly fatigued, communicate this with the family. Be aware that stressful situations, such as final exams can exacerbate migraines and whenever possible help the student work through the stress.   Confront bullying whenever it occurs.
 
Obviously, it is the goal of all involved, teachers and school, medical professionals, parents and the students themselves, to make sure that our patients/your students are successful travelers through the school years.
 
Howard S. Jacobs, MD, Associate Professor of Pediatrics, Co-Director, Pediatric Headache Clinic, University of Maryland, Department of Pediatrics, Baltimore, MD.
 
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