HeadWise HeadWise: Volume 4, Issue 4 - Page 26

“Recognizing triggers, preparing a treatment plan, and anticipating the changes in advance will give your teenager the best tools to keep his or her migraines managed.” Paying attention to the above-mentioned triggers and their role in headache may be helpful. For instance, a teenager who suffers from migraine exclusively on weekends may do well to avoid oversleeping. Naturally, the college environment will be less structured than it was at home. Meals will be less nutritious, sleep patterns will be irregular, and classes and roommates will pose new demands. Stress, both good and bad, is perhaps the most common trigger for migraine, and will be an inevitable part of adjusting to the new pressures of college. It is important, then, to work closely on the triggers your teenager can control – like staying well-hydrated (with at least 2 liters of non-caffeinated fluid daily), eating regularly with balanced meals, maintaining an exercise regimen, and avoiding caffeine-overuse (no more than 200mg caffeine daily, about 2 regular cups of coffee), and known food and alcohol triggers. The prospect of a roommate may be tricky. While sharing living space with a peer is a unique social opportunity in the college experience, it also means giving up some control of the environment. Freedom from the above triggers and access to a dark, quiet, snore-free, scent-free surrounding when migraines do occur may not always be available. Roommate housing options vary widely. Options allowing for some degree of private space, like multi-unit suites with shared common space, may be feasible for some migraineurs. Although, for those who suffer more frequent and/or severe headaches, any shared situation might be untenable and teenagers may opt for a single room allowing them exclusive control of their space. A physician’s note is usually required, and it is best to make this request early. Even with optimal lifestyle management- avoidance of 26 HeadW ise ® | Volume 4, Issue 4 • 2015 triggers and an ideal roommate situation, occasionally migraines will inevitably occur. Having a plan in place before your child leaves for college is essential to tackle this situation. You should share the headache diary with your child’s physician months before leaving for college. If there has been a recent change in your child’s headaches, your physician may decide to run tests to exclude underlying medical problems (such as anemia and thyroid dysfunction). If the headaches are being inadequately treated, this is an opportunity to try alternate rescue medications. Additionally, if headaches are frequent (usually above 5 days per month) or intrusive, there may be a role to initiate a preventive regimen. This usually involves prophylactic medication, but other options may include specific vitamin supplementations, addressing comorbid mood disorders, biofeedback training, physical therapy, and acupuncture. These preventive strategies raise the headache threshold and make it harder for the brain to generate headache – the goal being to decrease the migraines’ frequency, severity, duration, and/or improve response to rescue medication. These medicines take around 6 weeks to take effect, and finding the correct regimen may require trial and error, so it is important to begin working with your physician on this plan as soon as possible. With the transition to college come new challenges for those with migraine. Teenagers prepare with standardized testing and rigorous applications, but planning for migraine care is just as important. Recognizing triggers, preparing a treatment plan, and anticipating the changes in advance will give your teenager the best tools to keep his or her migraines managed in the background, and allow him to be fully present in the college experience. HW