Migraine information for schools

Migraine information for schools

About children and migraine

Migraine is a complex and disabling inherited condition that affects around four to ten per cent of children.

Perhaps because migraine in children can involve subtly different symptoms to adult migraine, half of those affected never receive a diagnosis.

With migraines in children and young people, stomach pains are more frequent. Studies suggest that around 60 per cent of children aged between seven and 15 experience headaches, but a diagnosis of migraine may be delayed because tummy pain, vomiting, travel sickness, limb pain and episodic dizziness can all confuse the picture. Children may experience migraine without headache, which is less common in adults.

Migraine can have severe impacts on the life of a child, affecting their family relationships, school life and social activities.

A late or missed diagnosis can result in poor management of their symptoms, anxiety about future attacks, poor school attendance, inappropriate or ineffective medication use, a loss of confidence and low self-esteem. Severe pain and vomiting that aren’t treated effectively can mean that children often have to remain at home during attacks and are unable to participate in normal daily activities.

The pattern of migraines in teenagers starts to change. Migraine affects boys and girls equally until puberty, after which migraine is more common in girls.

Identifying migraine in children

Migraine in children can differ from migraine in adults in several key ways:

• Headache typically affects the forehead and temple areas, or the whole head, rather than just one side
• Abdominal pain and/or vomiting are common and may recur even without headache
• Headache may be only a minor symptom or may not feature at all
• Attacks are often shorter, sometimes lasting less than an hour

As in adults, children are often pale and lethargic.

There is no test to identify migraine, so diagnosis depends entirely on the history and pattern of attacks.

In otherwise healthy children, recurring bouts of headache or stomach pain with nausea or vomiting are probably caused by migraine if the periods between attacks are free of symptoms.

Sensitivity to light, sounds, smells or touch can also occur, giving further clues to the diagnosis. Some children look pale and yawn for a few hours before the headache starts; others are bursting with extra energy.

Some children may experience migraine aura, typically involving bright, visual zig-zags or blind-spots, that can last up to an hour before the headache starts. Attacks may last only an hour or two, especially if the child can rest in a quiet, dark room and takes simple painkillers quickly.

Migraine and school

In a study in Norway, the prevalence rate of migraine for students aged 13 to 18 was found to be seven percent (Zwart, Dyb, Holman et al 2004), with girls having significantly more frequent headaches than boys.

Kernick, Rheingold and Campbell (2009) reported that 10 per cent of 12- to 15-year-olds in three Exeter schools had headaches that significantly impacted on their educational functioning, with on average seven school days each year being lost.

In children, sickness and abdominal pain are more prominent, with headache a secondary symptom (MacGregor 2012).

It is important to note that episodes can be quite brief, so providing opportunities to recover in school, as distinct from sending the child home, enables children to benefit from the remainder of the school day.

If the child’s migraine reoccurs over a period of at least a year and has an adverse effect on the child’s ability to carry out normal day-to-day activities, it is classified as a disability under the Equality Act 2010 and schools have a duty to make reasonable adjustments to avoid any disadvantage that arises from it.

Additionally, Section 100 of the Children and Family Act 2014 places a duty on maintained schools and academies, including special schools and PRUs, to support pupils who have medical conditions at school. Statutory guidance on supporting pupils at schools with medical conditions was issued in 2014 to assist schools in fulfilling this duty.

Prevention is a key strategy and it is important to be aware of some of the triggers for migraine attacks, so they can be avoided.

Triggers for migraine attacks

Common triggers include:

• A disturbed sleep pattern
• Missing meals or not eating enough
• Not keeping fully hydrated
• Stress, such as caused by exams or family problems
• Exercise or muscular stress, such as brought on by sudden physical exercise
• Environmental issues, like bright lights or working on a computer screen for too long
• Health issues, such as colds or starting a period

Some but not all of these triggers can be managed.

Management of migraine

Students should learn to manage their own migraine, but it is also the legal duty of schools to make reasonable adjustments to accommodate the needs of those with a disability. Reasonable adjustments to accommodate the needs of a student with migraine include:

• Devise a Health Care Plan
• Allow opportunities to drink frequently
• Permit breaks from working too intensively on computer screens
• Provide opportunities for healthy snacks/breakfast club if required
• Substitute yoga or other low energy activities for team games or sports
• Allow glucose tablets before games, plenty of fluid and a snack at half-time
• Give extended timescales for the completion of coursework
• Provide additional time in exams (subject to the agreement of the examination body) as a way of relieving stress
• Give opportunities to self-medicate (subject to medical advice) within school or college.
• Allow access to a quiet, dark room (medical room) to lie down in to manage a migraine attack

Schools should refer to statutory guidance produced by the Department for Education in September 2014: ‘Supporting pupils at school with medical conditions’.

Mitigation

Should a pupil be unfortunate enough to either miss or underperform in a public exam as a result of a migraine attack at the time of the assessment, they may be eligible for a post-examination adjustment to their mark. The current Joint Council for Qualifications guidance to the special consideration process should be consulted.

References

1. Department for Education. Supporting pupils at school with medical conditions. Department for Education 2014
2. Department for Education. The Equality Act 2010 and schools. Department for Education 2014.
3. Kernick D., Reingold D. and Campbell J. L. Impact of headache on young people in a school population., The British Journal of General Practice 2009; 59 (566): 678-681.
4. MacGregor A. Understanding Migraine and Other Headaches. Family Doctor Publications 2006.
5. Zwart J.A., Dyb G., Holman T.L., Stovner L. J. and Sand T. The prevalence of migraine and tension-type headaches among adolescents in Norway. The Nord-Trondelay Health Study (Head-Hunt-Youth), a large population-based epidemiological study. Cephalalgia 2004; vol. 24(5): 373-9.