How to help students with migraine succeed at school
For kids with migraine, navigating school and after-school activities can feel difficult and overwhelming. While 1 in 11 children have migraine—a number similar to the 1 in 12 children living with asthma—the visibility of students who experience migraine is much lower. Dr. Scott Turner, a nurse practitioner with neurology service at the Children’s Hospital of Alabama and assistant professor of pediatrics at the University of Alabama at Birmingham, spoke to AMF about pediatric migraine action plans, how to implement one and how they can help.
A pediatric migraine action plan is a written plan for children and adolescents who have migraine. The plan helps them manage the disease more effectively at home, in school and during after-school activities. Dr. Turner explains that these children don’t usually have a plan in place that allows them to take their medication at school and hopes that pediatric migraine action plans (or PedMAPs) will be a tool for school nurses to help students manage the disease at school with minimal impact to their learning.
What Does a Pediatric Migraine Action Plan Look Like?
The pediatric migraine action plan is divided into three colors like a traffic light. Each color illustrates the student’s game plan for treatment as their headache progresses. Dr. Turner explains, “The green zone tells them what to do to help prevent more headaches. The yellow zone tells the child or caregiver what they can do to try to treat a headache when it first starts.” This may include specific instructions that a school nurse can follow to give the student medication at school, if necessary. “It also has a red zone that tells caregivers what they can do if the child’s plan isn’t working or if new or concerning symptoms arise,” says Dr. Turner. This section of the form contains signals that parents should watch out for so they can notify the healthcare provider.
The form also contains a headache toolbox. This gives children and adolescents some self-management skills for use at home, school and beyond. “A parent also can use the second page of the plan to go to the school and advocate for an individualized health plan,” Dr. Turner says.
How to Create a Pediatric Migraine Action Plan
Dr. Turner explains that families can download the pediatric migraine action plan form and bring it to their physician. He says, “One of the strategies we’re trying to do is get school nurses to give it to children when they come into the health office complaining of headaches. That way they can take it back to their healthcare provider.”
The plan should be specific to the student’s needs. This includes successful activities that tend to work for the student. It should also include other personal information, such as the child’s diagnosis, medication options and how to contact a parent. It’s designed to be customizable and easy to fill out because there’s no one formula that works for everybody. “You really have to investigate a little bit about what the different triggers might be or what kinds of challenges a child’s facing in terms of lifestyle management,” Dr. Turner says.
The pediatric migraine action plan is a group effort. The form is filled out mostly by a pediatrician, nurse practitioner or headache specialist. However, Dr. Turner says, “The green zone is filled out together with the parent, the child and the provider—usually setting one or two healthy lifestyle goals. If the headaches are coming really frequently, they may want to add either a medicine or a vitamin as part of a daily regimen to reduce the number of headaches they’re experiencing.” But all the adults in the child’s life—parents, doctors, teachers, club leaders and the school nurse—are responsible for sticking to the plan.
Dr. Turner recommends that once the document is complete, parents should talk to the teacher and the school nurse to get them on board and make sure that they are familiar with the plan and the child’s diagnosis. “Most schools require a specific form to be signed to be allowed to give the child a medicine at school. We’re hoping the PedMAP could be that form,” he says.
Benefits of a PedMAP
Decreases disruptions to education
According to Dr. Turner, having a pediatric migraine action plan provides a streamlined process to deal with migraine at school and home. It also helps lessen the impact on a child’s education. An effective plan “helps reduce the number of school absences for children and adolescents with migraine,” he says.
Prevents migraine from becoming chronic
When it comes to young people with migraine, “There’s evidence that suggests if you can treat headaches effectively when they first start, that they may not come as often in the future, ” he explains. On the other hand, failure to treat headaches well at the beginning often leads to more frequent migraine attacks. To that end, sticking to a treatment plan now has long-term benefits for the child.
Just knowing there is a plan can help with some of the anxiety that students feel about coming attacks. Dr. Turner says, “One of the things that I think people that have migraine deal with is feeling helpless when they don’t have anything to do to manage an attack. They can’t prevent them and if they don’t have access to medicine, they may not be able to treat them effectively. And as a result, they miss out on life.” According to Dr. Turner, this worry can even cause children to avoid activities they would normally enjoy because they are afraid of getting a headache. The PedMAP gives them back a sense of control.
Accommodations or special services
Dr. Turner explains that the PedMAP also contains information about accommodations, which are “special services that the school can do to try to help the child that might be falling behind because of their headaches.” In some cases, accessing these accommodations requires having a formal 504 plan, a document created for a student with disabilities that requires schools to provide accommodations specifically tailored to that student’s needs. Dr. Turner notes that “other times it just requires a little bit of flexibility from the school staff.”
PedMAPs also help kids manage their own headaches and, with parent support, teach them to be their own migraine advocates. “They need to be willing to stand up and say, ‘Hey, I have migraine. I need to go to the nurse and take my medicine,’” says Dr. Turner. Pediatric migraine action plans also give parents a role—“to ally with the school to make sure that they know the plan.”
Advice for Parents
If you are caring for a child with migraine, Dr. Turner recommends creating a migraine action plan with your child’s healthcare provider, networking with other parents, reaching out to advocacy support centers or accessing online resources to gain more information.
He explains, “The problem with migraine is that nobody can see that you’re struggling. With asthma, you’re struggling to breathe. But when you’re having a [migraine attack], nobody really knows. And so you have to be the one to stand up for yourself. You have to be the one to say, ‘I need some help.’ Hopefully a plan like this will get kids the help they need.”
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.