Transcript MANAGING PAEDIATRIC MIGRAINE IN THE COMMUNITY

MANAGING
PAEDIATRIC MIGRAINE
IN THE COMMUNITY
SUE LIPSCOMBE
GP BRIGHTON
THE PROBLEMS
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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
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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
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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
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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