addressing headache in the school setting dr david kernick headache champion royal college general...
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Addressing headache in the school setting
Dr David Kernick
Headache Champion
Royal College General Practitioners
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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
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Why don’t children seek help?
Only 10% of child migraine sufferers present to GPMortimer 1992
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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
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Headache in schoolchildrenA complex biopsychsocial interaction
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Impact upon Quality of LifeLiterature review
34 studies
All demonstrated high impact
Poor methodological quality
Kernick Cephalalgia 2009
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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
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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
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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
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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
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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
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What happened to those that attended?
Migraine or probable migraine – 84%
Tension type - 10%
Mixed – 6%
Significant fall in PedMIDAS (median 17 to 6)
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What did we do?
Advice only – 6% Analgesia +-Domperidone – 63% Pizotifen – 33% Propranolol – 6% Amitrip – 6% Suma nasal – 18%
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What do children think?
Its only a headacheKernick D. J School Nursing 2011
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What do children think?
Impact of headache
Negative acceptance of the problem
Stigmatisation
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Its only a headacheKernick D. J School Nursing 2011
“Haven’t asked for help because headache is not serious - it’s just
a headache”
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Its only a headacheKernick D. J School Nursing
“I have not sought help because I don’t think anyone can help me.”
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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”
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Its only a headacheKernick D. J School Nursing
“They think I put it on - they don’t think I get them like I do.”
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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”
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School Policy Guidelines. RCGP, Headache UK, RCN
(rcgp.org.uk)
Advise for schools and supportive literature
Advise for School children
Advise for school nurses
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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