MANAGING MANAGING PAEDIATRIC MIGRAINE PAEDIATRIC MIGRAINE

IN THE COMMUNITYIN THE COMMUNITY

SUE LIPSCOMBESUE LIPSCOMBE

GP BRIGHTONGP BRIGHTON

THE PROBLEMS• GETTING TO SEE THE CHILD• MAKING THE DIAGNOSIS• GETTING CHILD TO UNDERSTAND THE DISORDER• GETTING PARENTS/GUARDIANS TO ACCEPT DIAGNOSIS

AND HELP• LETTING THE SCHOOL KNOW ABOUT THE INDIVIDUAL• HELPING THE SCHOOL WITH MANAGEMENT• HELPING TEACHERS UNDERSTAND THE PROBLEM• HELPING THE CHILD GET THE BEST FROM THEIR

EDUCATION WITH OPTIMAL SCHOOL ATTENDANCE AND ENJOYING THEIR SOCIAL LIFE

• SETTING TARGETS FOR THE FUTURE

BARRIERS FOR MANAGEMENT

• Reluctance of child, usually adolescents, to see the doctor

• Reluctance of child to come more than once with diaries etc

• Timing appointments to fit in with school life

MAKING THE DIAGNOSIS

• Often child and parents fed up with condition but also scared.

• Underplay by patient, overplay by carer

• Physical examination is vital

• Regular review to reinforce diagnosis

Getting Child to Understand what is wrong and how to help themselves

• Explanation especially when chronic headache which may last a lifetime

• Explanation of possible triggers and getting child to accept them

• Explanation that fit in with their life• Helping themselves without making life

worse for them -peers

Getting parents to accept and help

• Explanation that not all headaches need scans

• Explanation that other children have similar conditions

• Use of Migraine4kids site• Help with diaries and treatments• Allowing some leeway for the child

Help the school know about the individual

• Permission from child and parents to do so• Letting school know diagnosis• Letting school know of any medication

needed and side effects• Making appropriate allowances• Making sure all teachers and staff have the

information

Educating the school about management

• Individual management of the child• When to allow medication to be used• When to allow time out• When to send child home• When to make allowances and when not• When to communicate with doctor with

patient/parent agreement

Educating Teachers about Headache

• Often teachers keen to learn new things• Evening meetings• Lunchtime meetings• A day course for pupils and staff eg Migraine

awareness day• Assembly talk• Talk at Parents Evening• Speaking with School Nurses if possible

Acute Medication• Depends on age of child and varying

situations demand different medications• Different ages require different formulations

i.e.liquid, nasal, suppository, melt or tablets• Ability to have somewhere to sleep is

important.• Acceptance of school for child to take acute

medication

Prophylactic Medication• Need to explain to parents and child (if

able to understand) how prophylactics work and why they must be given daily

• Adjusting the doses as child grows• Explaining may need to change

prophylactics to get best effect for child as an individual.

Helping child get best from education and social life

• Keeping diaries and identifying triggers• Alerting teachers if they need medication. Card

system• Talking through the pros and cons of triggers ie

over/underwork, sleep• Getting friends on board by education• Asking for letters for exams and course work if

appropriate• Offering letters if child reluctant.

Setting the picture for the Future• Public examinations• University triggers• Work and time off worries• Possible pathway of the condition• Constant reappraisal of any medication• Awareness of adult websites and

research

Getting it Right• Though some of these points may

seem obvious not all doctors are as interested as we are.

• When seeing child/adolescent may need to make suggestions re management and letters to GP