When School Absences Become a Problem

By Kathleen Farmer, PsyD, Headache Care Center, Springfield, Missouri

Missing school and social activities is all too common for children with severe or frequent headaches. While the impulse to protect children in pain is understandable, not going to school is rarely the answer. The story of 17-year-old Tina helps to illustrate this.

Tina has been home-schooled for the past two years of high school due to debilitating chronic migraine headaches. Finally, her mother brought her to a headache clinic because Tina wanted to become well enough to attend college in the fall.

Are headaches a way to avoid school?

Not for Tina: Tina's favorite subjects in high school were math and science, and she missed learning about them in the school setting. She also felt isolated from her peers by being home-schooled. She did keep in touch with friends via text-messaging and she would schedule time to be with them away from home for a few hours over the weekend. Headaches always accompanied her on these excursions but she tolerated them to be with friends.

Solution: Tina, like other migraineurs, needs to understand that migraine results from the interaction of a predisposed nervous system with an overly demanding environment. There are tools to manage migraine, such as biofeedback and keeping a regular schedule of meals and sleep time. The occurrence of a migraine is a signal that the child may need more time to relax and play. If migraine generally begins at school, parents need to discuss the problem with the school counselor and the teacher. If the child feels a migraine coming on, the child should have the option of telling the teacher and visiting the school nurse for a quiet place to practice biofeedback or to take medication and rest for 15 to 30 minutes. The child then returns to the classroom. Staying at school is essential.

Is the child a perfectionist?

Not inherently: Because children with migraine inherit a very sensitive nervous system, they are attuned to the expectations of parents, siblings and others close to them. They often take on the responsibility of avoiding conflict before it occurs. With their antennae picking up possible clues to unrest, they may become perfectionistic as a way of making their parents and others happy with their performance. They may expect themselves to be liked by everyone, to be straight-A students, and be involved with many extracurricular activities. Under the stress of being unable to achieve the impossible, the child's nervous system becomes overwhelmed.

Solution: The child needs to understand that being human means being imperfect. It is okay to be imperfect and mistakes are effective ways to learn. The child's focus needs to shift from what others expect to what is in the child's best interest.

Can trauma cause increased headaches?

Yes for Tina: Headaches gradually increased during Tina's sophomore year. Tina's mother had invited a Swedish foreign exchange student to live with them. Nina was petite, blonde, smart and very outgoing, the opposite of Tina's judgment of herself. Tina felt inferior and as a consequence, she withdrew from her friends and refused to attend social events. She didn't want to be seen with Nina because she felt out-classed. Tina's mother misinterpreted this as jealousy and offered no emotional support. She considered Tina to be ungrateful for her attempts to provide Tina with a “sister.” Instead, Tina saw Nina as a competitor and herself as a loser.

Solution: A trauma that upsets a migraineur's sensitive nervous system can be physical, such as a bicycle or auto accident, or psychological. For Tina, the foreign exchange student's involvement in her life was traumatic. Unfortunately, her mother did not understand Tina's reaction, which made the ordeal even more hurtful. For an event to increase headache frequency, a child must perceive it as traumatic even though a parent may be baffled by the child's reaction. Acceptance of the child's perception is the first step in helping him or her cope with the perceived trauma.

If your child experiences headaches that are keeping him or her from participating in school or other activities, please consider seeing a headache specialist. Visit www.headaches.org to find a specialist near you.