We know that headaches in children and young people have a negative impact on quality of life, in particular on school performance, activities and social interaction. However, research is also showing that there is an impact on children and young people’s mood and mental health. Studies have found a higher rate of difficulties with behaviour, attention, sleep, self-esteem, anxiety and depression in adolescents with recurrent, tension headache and migraine.

Taken together it is clear that physical symptoms are not the only thing children and young people have to contend with and so we need to consider how best to support them with the emotional as well as physical and social functioning aspects of headache conditions. Below are some suggestions as to how to approach this.

1. Hear their experience:

It can be really difficult for young people if they feel they are constantly missing out on activities, time with friends and important school days. Allowing them space to talk through the impact of their migraines can help it to feel like a shared experience and one that they are supported with. This does not mean we need to focus on all of the missed opportunities all of the time. It’s ok to encourage them to do what they can but just allow them to voice frustrations where possible and validate their experience. 

2. Recognise your child’s and your own reaction to pain and distress:

We know that distress about pain can affect coping and adjustment to the pain. Therefore, normalising when your child is experiencing pain and being as calm as possible is going to be key here. If your child does not want to talk through what is happening it can be a good idea to just support them using coping strategies. For example, helping them learn how to relax. Relaxation could also be something you do together such as deep breathing, listening to relaxation music, going on walks, or watching a movie. The less distressed we are when experiencing pain, the better we are able to cope with it.

3. Discuss their needs at home and at school:

Allowing space to talk through difficulties is important for validating and normalising your child’s experience but it is also important to see if any helpful adjustments can be made. Depending on how old your child is, allowing them to come up with ideas can help empower them in what can feel like a disempowering condition. Perhaps sitting down with teachers and as a family at home, to show them everyone is on board to support them. Adjustments could include prompts for homework, time limits for assignments, downtime as soon as they come in from school, or a good wind down routine for sleep.

4. Encourage your child to recognise all aspects of their identity:

Your child may feel that migraines define who they are, especially if they feel “different” to peers when taking time off school or wearing tinted glasses. Try to recognise that migraine is indeed a part of their life, but that there are other things too. Take time to talk about their qualities (e.g., being kind, funny), rather than just the things that they achieve and do, which can feel dependent on how well they are.

5. Help to make your child’s interests and hobbies manageable:

Try to allow time to encourage interests and other areas of importance in your child’s life, but make this manageable for them so they have greater confidence to do these things even with headaches. For example, if they want to go to a party, you might decide together to just take small steps, like agreeing to go to half the event, or you might put a plan together in case a migraine happens during the party.

6. Practice building confidence about difference:

Feeling different to others can feel challenging; but we know that for some, being different has been an asset to their lives. You may be able to think together about role models who have used their difference as an advantage, or where it has highlighted their personal qualities. In dealing with peers, it can be helpful to have a response ready that they can give to inevitable questions. Some like to give a manageable and clear explanation, whilst also guiding the conversation elsewhere, e.g. “I have a condition called migraine, but it’s ok because my glasses help me cope with bright lights. Oh, are you heading to the canteen?” You could practice this together or other strategies for communicating about headaches. Find out more about isolation and migraine and coping with it here.

Key messages for you and your child

• Migraines are not just a physical experience and can have an impact on emotions and behaviour
• Try to have calm, uninterrupted and open conversations together about what is happening and how they are feeling
• Migraines can also affect identity and self-esteem: recognise other parts of who they are and make hobbies more manageable
• Consider your own responses to the condition: this is hard for parents to live with too and many find it helpful to seek their own professional support.

Further resources and help

• Look for options for professional support: counselling through school, psychology services through any medical teams your child is attached to, or Child and Adolescent Mental Health teams (CAMHS) through your GP
• Further reading for you: “Helping your child with a physical health condition: A self-help guide for parents” by Dr Mandy Byron and Dr Penny Titman.

References

Blaauw, B. A., Dyb, G., Hagen, K., Holmen, T. L., Linde, M., Wentzel-Larsen, T., & Zwart, J. A. (2014). Anxiety, depression and behavioral problems among adolescents with recurrent headache: the Young-HUNT study. The Journal of Headache and Pain, 15(1), 1-7.

Crombez, G., Bijttebier, P., Eccleston, C., Mascagni, T., Mertens, G., Goubert, L., & Verstraeten, K. (2003). The child version of the pain catastrophizing scale (PCS-C): a preliminary validation. Pain, 104(3), 639-646.

Dyb, G., Stensland, S., & Zwart, J. A. (2015). Psychiatric comorbidity in childhood and adolescence headache. Current pain and headache reports, 19(3), 1-8.

Gazerani, P. (2021). Migraine and mood in children. Behavioural Sciences, 11(52), 1-15.

Pakalnis, A., Splaingard, M., Splaingard, D., Kring, D., & Colvin, A. (2009). Serotonin effects on sleep and emotional disorders in adolescent migraine. Headache: The Journal of Head and Face Pain, 49(10), 1486-1492.

Pinquart, M. (2013). Self‐esteem of children and adolescents with chronic illness: a meta‐analysis. Child: care, health and development, 39(2), 153-161.