How to Create a Routine that Works for Your Child with Migraine

In a challenging school year, you can support your child with migraine by keeping a consistent schedule and managing stress

This school year is unlike any other. All the change and uncertainty can lead to extra stress for your child. Stress can be a trigger for many children with migraine and make pain worse. That’s especially the case in a brain that’s already sensitive to change.

As a parent, you can make this time easier by understanding how stress impacts migraine. In the process, you create an effective schedule and set realistic goals. This will help you and your child figure out what works to manage their migraine attacks.

How Stress Impacts Migraine

In times of crisis like the current COVID-19 pandemic, stress is increased. This causes your child’s “fight or flight” response to work overtime. Stress can also present in different ways in children than in adults, says Dr. Dina Karvounides, a pediatric psychologist at the Children’s Hospital of Philadelphia. Children might express stress in physical ways. For example, they may report stomach aches or show changes in mood such as increased irritability.

Dr. Karvounides says that because stress can look different in children, it’s important for parents to try to figure out the signs that their child is feeling more stressed and try to notice the symptoms that come on prior to a migraine attack.

Create a Routine that Works

Maintaining a regular schedule for children with migraine is very important. That schedule should include a wake time and sleep time that are the same every day, healthy eating habits (like not skipping meals), daily exercise, hydration, relaxation, and fun.

It’s essential to set clear boundaries around different parts of your child’s day. You should be intentional about scheduling time for fun and relaxation. “It’s so easy for our boundaries, whether for children or adults, to become blurred when you’re doing everything from home,” says Dr. Karvounides.

You should also set a time for your child to end school work and homework, says Dr. Alexandra Ross, a psychologist at the UCSF Benioff Children’s Hospital. “Just because school is at home does not mean you are at school all of the time,” she says. Dr. Ross also recommends writing down the schedule and putting it in a place that’s easy to see, like near your child’s work station.

If your child is spending a lot of time working on a computer, it’s also important to include planned breaks as part of their schedule. It’s recommended to schedule these breaks before you think your child will need them. For example, if you notice your child starts to get a headache after 30 minutes of screen time, you might schedule breaks after 25 minutes of screen time.

While a consistent schedule for children with migraine is important, it’s also important to adjust that schedule as needed if your child has a migraine attack so they can stay on track while also taking care of themselves.

Set Small, Manageable Goals

Any time you’re working on adjusting behavior, it’s important to set small, specific, and realistic goals, says Dr. Ross. For example, if a child notices that they’re drinking one 16-ounce bottle of water a day, setting a goal to get up to the recommended 64 ounces a day may be too much in one step. Instead, Dr. Ross suggests setting a smaller goal, such as drinking two 16-ounce bottles by the end of the day, perhaps finishing the first by the end of lunch period and the second by dinner time. Once that goal is reached, you and your child can work together to set another goal.

Similarly, if a child is working on building a relaxation practice, like deep breathing or meditation, into their day your family might set a goal of starting with a few two-minute breaks rather than a 15-minute session right away.

It’s also important to keep these tools, like water bottles, in plain sight. “When kids are at in-person school and they’re getting up and doing things, there are some natural times when they’re reminded to engage in the self care activities that work for them,” Dr. Ross says. “When children are sitting at their desks all day, it just may not happen as naturally.”

Manage Stress and Relax

It’s important for children with migraine to engage in activities in a schedule that can reduce stress and help them relax. You can encourage your child to engage in activities they enjoy or even suggest they take up a new hobby. Staying connected with friends can also help reduce stress. Even if your child doesn’t feel like socializing, you should encourage them to keep plans. It might make them feel better than they thought. Engaging in the community, by helping out an elderly neighbor or participating in a fundraiser, can also help your child feel connected and reduce stress.

Starting a relaxation practice is another way to reduce stress. There are several online resources and apps for relaxation, deep breathing and mindfulness such as Headspace, Calm, Stop, Breathe & Think, and Smiling Mind. Even just journaling, drawing or baking can help your child relax and disconnect from social media.

Here are a few simple exercises you can help your child do:

  • Belly Breathing: Imagine a balloon is in your stomach. As you inhale through your nose, fill your stomach with air (expand the balloon) and as you exhale, release (deflate the balloon).
  • Progressive Muscle Relaxation: While laying down, start with squeezing your toes tightly for 5-7 seconds. Then release and let your toes fully relax. Move up to your calves and do the same thing with each of your muscle groups until you move through your body’s muscles up to your head.

It’s also helpful to encourage your child to be open and honest with you if they feel unmotivated or unfocused. You can also encourage your child to notice when they’re focusing on negative thoughts. You can have them ask themselves what they would tell a friend who was having those worried thoughts.

Figure Out What’s Effective

To figure out what practices and routines work for your child, it can be helpful to collect some simple information, says Dr. Ross. Let’s say your child has a big test coming up and they ended up studying late and going to bed later than usual. They might notice they have a migraine attack the next day. Noting what they did differently—doing school work closer to bed or staying up later—can help you and your child problem-solve and come up with strategies that might help manage migraine the next time they have a big test.

Kids, particularly kids with continuous headache or chronic migraine, may also learn about the strategies most helpful for them by focusing on what they did on the days they felt better, Dr. Ross says. For example, if there’s a day when your child feels better, note what they did differently. Did they go to bed earlier? Did they eat breakfast? This can help you adjust your child’s routine.

For kids who have frequent migraine attacks, it can sometimes be difficult to remember what their attack was like three days ago, says Dr. Ross. A simple color coding system completed daily can be effective here.

Mark days in this way:

  • Blank=no headache
  • Green=mild headache, not getting in the way of normal activities
  • Yellow=moderate headache, engaging in normal activities but with noticeable discomfort
  • Red=severe headache, impairing functioning

Recognize the Positive

While this school year brings new challenges, it’s important to note how resilient kids are, says Dr. Karvounides. “I’m very inspired by the way that kids have been able to adapt to everything that’s happened around them,” she says. “My hope is that kids are really recognizing their own resilience in working through things that are really hard.”

This time can even present some opportunities. Dr. Ross is talking to her patients, who often participate in several activities and have a lot of homework, about using this time as practice to figure out what it looks like to take really good care of themselves during the day. “They are working to  build habits and practice self-care strategies. The goal is for this to be built in as a natural response that they can draw from in the future when they have returned to a busier routine,” she says.

The American Migraine Foundation is committed to improving the lives of those living with this debilitating disease. For more of the latest news and information on migraine, visit the AMF Resource Library or Pediatric Migraine Content Hub. For help finding a healthcare provider, check out our Find a Doctor tool. Together, we are as relentless as migraine.