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My Head Hurts

A growing number of children and teenagers suffer from frequent or persistent headaches, including migraines, that can be debilitating and significantly impact their quality of life.  In many school health offices, headaches are one of the top reasons a student visits the school nurse and a leading cause of school absenteeism.  When a student complains of headache in the school setting, the school nurse assessment consists of thorough collection of the student’s headache and other pertinent history as well as a careful physical exam.  Appropriate assessment and treatment of headaches, including recognizing patterns and identifying potential causes, by the school nurse is imperative to supporting students with headaches for success in school.

There are many different types of headaches, 95% of which are safe and not cause for major concern, they can be extremely disruptive to a student’s ability to learn, engage and thrive in school.  Tension headaches and migraine headaches are the two most common types of headaches in the pediatric population.  Tension headache pain occurs from an interaction of signals between the brain, blood vessels and surrounding nerves while migraines, which are hereditary, result from an electrical disturbance in the brain causing chemical changes that can lead to symptoms including head pain, photosensitivity and nausea.

By the time they reach high school, 20% of kids experience recurring tension headaches or migraines and studies show that headache-related disability leads not only to the aforementioned school absenteeism, but to decreased levels of self-esteem, declines in academic performance, and reduced quality of life. Early identification and initiation of evidence-based treatment management is critical and school nurses are favorably positioned to play a pivotal role in preventing these negative headache effects in children.

Tension headaches typically involve consistent, bilateral pain to the head, often described as feeling like “a band around the head”.  They tend to worsen with routine activities (bending, walking, etc) but are usually responsive to over-the-counter pain medication as well as nonpharmacologic interventions.  Migraines, on the other hand, involve throbbing or pulsing pain lasting hours to days that can also be accompanied by nausea, vomiting, and sensitivity to light, noise or odors. The combination of visual disturbances, sound assaults and thought interruptions that occur with migraines can be an agonizing onslaught.  What is it like?

Create a headache experience here or have students share exactly how they are affected.

Through obtaining a detailed history and performing a focused assessment, patterns, associated symptoms, and any precipitating factors can be properly identified and addressed. Sleep, hydration, relaxation, diet, and physical activity recommendations should be considered and explored with families when providing headache education.  If migraine is suspected or headaches are present for more than four weeks, referral to a primary care provider is appropriate.  A headache diary can be an effective tool in determining potential triggers and revealing patterns in preparation for the primary care appointment.  Requesting a headache action plan can help the school nurse implement effective headache management in the school setting through the facilitation of necessary accommodations, support in avoidance of triggers, and administration of prescribed treatment protocols.

Headaches can be a progressive disorder but with early recognition, prompt intervention, and appropriate referral and management, the school nurse can change the trajectory and improve the quality of students’ lives.

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