Addressing headache in the school setting

1. Addressing headache in the school setting Dr David Kernick Headache Champion Royal College General Practitioners

2. Background • Headache most frequent neurological problem in children and commonest manifestation of pain • 10.6% school children have migraine Abu Arafet 1995 • 50% Childhood migraine becomes chronic and continues into adulthood Fearon 2001

3. Why don’t children seek help?Only 10% of child migraine sufferers present to GP Mortimer 1992

4. Why don’t children seek help?Only 10% of child migraine sufferers present to GP Mortimer 1992 • Don’t realise its migraine • Only a headache • Parents don’t want to reinforce illness behaviour • Parents pattern their health seeking behaviour

5. Headache in schoolchildren A complex biopsychsocial interaction

6. Impact upon Quality of LifeLiterature review Kernick Cephalalgia2009 • 34 studies • All demonstrated high impact • Poor methodological quality

7. Impact upon quality of life Kernick BJGP 2009 • 1030 children 12-15 years (Socioeconomic status = UK average) • Measured problematic headache frequency and impact (PedMIDAS) • Generic quality of life measure (PedsQL4)

8. Impact upon quality of life Kernick BJGP 2009 • 20% - 1 or more headaches each week, PedMIDAS Impact score 12 • 10% - 2 or more headaches each week, PedMIDAS impact score 17 • 10% - Generic quality life score worse than asthma, diabetes, cancer.

9. What is happening in primary care? Kernick Cephalalgia 2009 • Case controlled data base study • 50,000 new headache presentations age 13-17 • 0.6% of GP consultations

10. What is happening in primary care? Kernick Cephalalgia 2009 • GPs made diagnosis in 20% • 25% referred to secondary care • 3 in 10,000 tumour (none if migraine diagnosed)

11. What is the unmet need in primary care? Kernick Journal of Headache and Pain 2008 • 2500 children age 8-17 • 74 (3%) accepted invitation • Impact score 17 days in three month period (3.5 days of lost school) • Only 49 (66%) attended

12. What happened to those that attended? • Migraine or probable migraine – 84% • Tension type - 10% • Mixed – 6% • Significant fall in PedMIDAS (median 17 to 6)

13. What did we do? • Advice only – 6% • Analgesia +-Domperidone – 63% • Pizotifen – 33% • Propranolol – 6% • Amitrip – 6% • Suma nasal – 18%

14. What do children think? Its only a headacheKernick D. J School Nursing 2011

15. What do children think? • Impact of headache • Negative acceptance of the problem • Stigmatisation

16. Its only a headacheKernick D. J School Nursing 2011 “Haven’t asked for help because headache is not serious - it’s just a headache”

17. Its only a headacheKernick D. J School Nursing “I have not sought help because I don’t think anyone can help me.”

18. Its only a headacheKernick D. J School Nursing “I have had them since I was so little I don’t think there is much I can do”

19. Its only a headacheKernick D. J School Nursing “They think I put it on - they don’t think I get them like I do.”

20. Its only a headacheKernick D. J School Nursing “Teachers are not sympathetic they just say to sit quietly but I can’t concentrate on my work” “Teachers think that you just want to get out class”

21. School Policy Guidelines.RCGP, Headache UK, RCN(rcgp.org.uk) • Advise for schools and supportive literature • Advise for School children • Advise for school nurses

22. In conclusion • High area of unmet need but poorly managed • Area where simple interventions very big difference • Schools are well placed to reduce the impact of headache on children