Post on 19-Jan-2016
Addressing headache in the school setting
Dr David Kernick
Headache Champion
Royal College General Practitioners
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
Why don’t children seek help?
Only 10% of child migraine sufferers present to GPMortimer 1992
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
Headache in schoolchildrenA complex biopsychsocial interaction
Impact upon Quality of LifeLiterature review
34 studies
All demonstrated high impact
Poor methodological quality
Kernick Cephalalgia 2009
Impact upon quality of life
1030 children 12-15 years (Socioeconomic status = UK average)
Measured problematic headache frequency and impact (PedMIDAS)
Generic quality of life measure (PedsQL4)
Kernick BJGP 2009
Impact upon quality of life
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.
Kernick BJGP 2009
What is happening in primary care?
Case controlled data base study
50,000 new headache presentations age 13-17
0.6% of GP consultations
Kernick Cephalalgia 2009
What is happening in primary care?
GPs made diagnosis in 20%
25% referred to secondary care
3 in 10,000 tumour (none if migraine diagnosed)
Kernick Cephalalgia 2009
What is the unmet need in primary care?
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
Kernick Journal of Headache and Pain 2008
What happened to those that attended?
Migraine or probable migraine – 84%
Tension type - 10%
Mixed – 6%
Significant fall in PedMIDAS (median 17 to 6)
What did we do?
Advice only – 6% Analgesia +-Domperidone – 63% Pizotifen – 33% Propranolol – 6% Amitrip – 6% Suma nasal – 18%
What do children think?
Its only a headacheKernick D. J School Nursing 2011
What do children think?
Impact of headache
Negative acceptance of the problem
Stigmatisation
Its only a headacheKernick D. J School Nursing 2011
“Haven’t asked for help because headache is not serious - it’s just
a headache”
Its only a headacheKernick D. J School Nursing
“I have not sought help because I don’t think anyone can help me.”
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”
Its only a headacheKernick D. J School Nursing
“They think I put it on - they don’t think I get them like I do.”
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”
School Policy Guidelines. RCGP, Headache UK, RCN
(rcgp.org.uk)
Advise for schools and supportive literature
Advise for School children
Advise for school nurses
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