It seems that there is an increasing trend that more students are having trouble going to school and staying in class as a result of have migraine headaches. One of the unfortunate consequences for children and teenagers who suffer from chronic headaches, or more specifically migraines, is that they miss a lot of school days. When this happens, the family and school need to work together, with help and support from the student’s medical team, to find a balance where the student can attend school as often as possible, plan for when he or she is unable to attend, and ultimately help the student make progress in his or her academic program.
Unfortunately, this fine balancing act can become very contentious. Although some school districts seem to recognize the medical validity of school absences due to migraines, in worst cases other school districts call truancy officers. There does seem to be an increas in district becoming more leary of medical notes for conditions that are not readily observable. Even in those cases where school districts recognize that accommodations need to be made, where and how these students will be educated can become the subject of dispute. A recent court case validates the efforts of a Pennsylvania school district to educate a high school student with refractory migraine headaches who had a 504 Plan by enrolling him in a “cyber school.” The family argued that their son should have been on an IEP where he could have received additional supports and services to help him attend school. Additionally, the family claimed that enrollment in a cyber school denied their son FAPE, or a free appropriate public education, because the cyber school was not the least restrictive environment. The family’s claims, however, were ultimately rejected by the court, which found that given the student’s inability to attend school and the school district's well-documented and numerous attempts to accommodate the student, the “cyber school” was his least restrictive environment and an appropriate placement.
Unfortunately, the student in the Pennsylvania case is not alone in his struggles with migraines. According to the Michigan Headache & Neurological Institute, approximately 2 to 5% of children below the age of 12 experience migraines, a number which increases to 10% by late adolescence. This adds up to a lot of missed school days. A 1989 National Health Interview Survey reported that headaches were the third highest cause of school absence. About 10% of students with migraines miss two school days per month, and 1% of these students will miss 2 days per week. One pediatric specialty group reported that their patients missed 6.3 days per month, or about 57 days over the course of the school year. Clearly, migraines can have a significant impact on a child’s education, and schools will need to determine, with input from the medical team and the family, what sort of support at school is needed to address the lost instructional time.
Whether a child is in need of an IEP instead of a 504 Plan can be a source of conflict between school and family. Some schools will qualify a student for an IEP under the eligibility of Other Health Impaired; others will not. If a child is determined to not have a disability that affects his or her progress in the general education curriculum, a 504 Plan should be offered. Accommodations, whether addressed in either an IEP or a 504 Plan, should include how the student will be helped to make up missed work or instruction and how future absences will be addressed. Migraine.com, a website which addresses issues related to migraine headaches, offers the following items to be considered as accommodations for the student who has migraines: no penalty for absences related to migraine symptoms;
- flexible due dates and no grade penalty for late work,
- access to a quiet space in the event of an attack during the day,
- alternate testing,
- late start times or attending only a certain number of classes per day,
- or under extreme circumstances, homebound services
Homebound services, which need to be certified by a doctor, represent the most restrictive educational setting for the student and should be used as only a temporary solution while efforts are made to return the student to school. Again, more schools are growing reluctant to honor doctor requests for homebound and even are seeking independent medical review.
Students who are amassing considerable absences due to migraines are under enormous emotional stress. In addition to feeling so unwell, these students are under deep pressure to keep up academically and socially, which may seem impossible to them, leading into a vicious cycle of new stress triggers leading to new headaches. Emotional issues can develop on top of the primary issue of retractable migraines. The family, medical professionals, and the school team need to watch the student closely to determine if and at what point the child’s emotional needs rise to the level of impacting his or her educational programming and then determine if an IEP has then become appropriate for those students who did not initially quality for special education services.
Families dealing with a child who has a chronic illness, such as chronic migraines, are under stress. Conversely, school districts can be left puzzled or fail to understand the student’s participation in events on days in which there has been a migraine-related school absence. Occasionally, trust is lost between the school district and the family. Therefore, parents must scrupulously play their part in maintaining relationships by adhering to the school district requirements for medical documentation to ensure that each absence is excused by medical professionals. It is unfair and unreasonable to ask the school to provide services yet refuse to provide appropriate medical records when requested. Both schools and families need to work together, create transparency and move past the current environment of mistrust that is all too prevalent.