Background information

Children suffer from migraine with episodes lasting between thirty minutes and forty eight hours. The prevalence rate of migraine in Norway for students aged thirteen to eighteen was 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% of 12 to 15 year olds in 3 Exeter schools had headaches that significantly impacted on their educational functioning, with on average 7 school days a 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, would enable them to benefit from the remainder of the school day. So migraine is common: 2 or 3 children in a typical class will have attacks and since there is significant under-diagnosis the real figure is likely to be higher.

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 then it is 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, from September 2014 Section 100 of the Children and Family Act 2014 places a duty on maintained schools and academies, including special schools and Pupil Referral Units (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:

ā  A disturbed sleep pattern

ā  Missing meals or not eating enough

ā  Not keeping fully hydrated

ā  Stress: for example exams, approaching deadlines for work, family problems

ā  Exercise or muscular stress e.g. brought on by sudden physical exercise.

ā  Environmental issues, e.g. bright lights, working on a computer screen for too long.

ā  Health, e.g. suffering from a cold, starting a period.

Some but not all of these can be managed.

Management of migraine

Students should learn to manage their own migraine, but it is the duty of schools to make reasonable adjustments to accommodate the needs of those with a disability (See the Equality Act 2010 and schools, DfE May 2014). Reasonable adjustments to accommodate the needs of a student with migraine include:

ā  Devise a Health Care Plan

ā  Allow opportunities to drink frequently.

ā  Permit breaks from working too intensively on computer screens.

ā  Provide opportunities for healthy snacks/breakfast club if required.

ā  Substituting yoga or other low energy activities for team games or sports.

ā  Taking glucose tablets before games, plenty of fluid and a snack at half-time.

ā  Giving extended timescales for the completion of coursework

ā  Provide additional time in exams (subject to the agreement of the examination body) as a way of relieving stress

ā  Opportunities to self-medicate (subject to medical advice) within school or college*.

ā  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’.

*Timing of medication is essential to be effective in migraine.  If the attack is not treated early it is much less likely to be effective.  Waiting to see if the attack is becoming severe or waiting for parents to arrive means the opportunity for effective treatment is lost.  Simple painkillers in adequate doses given at the earliest stage of the attack, followed by an hour’s quiet rest (and preferably sleep) will often mean the child recovers enough to complete the school day.

Mitigation

Should a pupil be unfortunate enough to either miss or under perform in a public exam as a result of a migraine attack at the time of the assessment then they may be eligible for a post-examination adjustment to their mark and 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.