School isn’t the only thing that begins in the fall. For many children, the stress of returning to classes brings an unwelcomed return to headaches.
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And in the age of COVID-19, that back-to-school stress isn’t easing up.
“It’s common for parents to suddenly hear their children complaining of headaches around this time of year,” says pediatric neurologist A. David Rothner, MD. “Especially now, when kids are still facing learning challenges from the pandemic and the uncertainty and lack of stability in their academic and social environments.”
Before the pandemic, an abrupt change in schedule with new social and academic pressures already added up to major stressors for children.
“Now, in addition to worrying about new teachers and classmates, kids have to think about staying healthy, wearing masks, making friends outside of remote classwork, and more,” says Dr. Rothner.
“There’s no question that COVID-19 is a contributing factor to the increase of stress headaches in children,” he says.
It’s important to communicate with your child about their specific worries and figure out the best plan of action to ease their worried minds.
The most common headache patterns for children
Children are subject to migraines as well as tension, or chronic headaches.
“Parents can easily recognize a child’s migraine coming on,” says Dr. Rothner. Signs of this severe, occasional headache include:
- Looking pale.
- Acting grouchy.
- Being bothered by light and noise.
- Not wanting to eat, nausea and vomiting.
For most children, the migraine ends within two hours on its own or with simple analgesics such as Tylenol® or ibuprofen. “Many kids fall asleep, which almost invariably ends the migraine,” he adds.
Tension or chronic headaches are milder, more frequent or near-daily headaches that don’t bring on nausea or other features of a migraine and tend to last most of the day.
About 1% of youngsters develop chronic headaches. “Youngsters with chronic daily headaches seem to be extraordinarily sensitive to the start of school and the associated stress that this brings, and typically fare the worst,” says Dr. Rothner.
He sees a spike in young chronic headache patients in the first weeks of classes and before school even starts these days. “Even before information on the new delta variant came out, I was starting to see an increase in patients with chronic headaches,” he says.
Understanding the impact of ‘pandemic life’
Headaches about going back to school are now enhanced with worries developed during a child’s time living in a pandemic state.
“There are social, educational and economic factors to consider here,” says Dr. Rothner. “Even if a child already went through a year of school during the pandemic, it doesn’t make it any easier on them to do it again.”
Below, are some examples of added stress factors your child might be experiencing:
- Not being able to make new friends since learning was entirely virtual the previous year.
- Not being able to socialize comfortably while wearing masks.
- Not being able to connect with a teacher while wearing masks.
- Fearing that other students and teachers may bring the virus to school.
- Worrying about who is vaccinated.
- Fearing that they fell behind last year and won’t be able to catch up.
- Learning new material in a classroom again versus online learning.
- Discomfort with interactive teaching lessons.
- Uncertainty of whether remote learning will be an option if there are COVID-19 cases at school.
For students who live in underprivileged neighborhoods and school districts, there is an additional layer of worry due to:
- Relying on being at school for snacks and meals.
- Not having access to technology at home.
- Finding transportation to and from school.
- Schools not having the proper equipment and technology to get the student back on track.
Encouraging healthy habits
“When your child’s headaches start cropping up, take a look at their lifestyle and behavioral habits,” says Dr. Rothner.
To minimize the likelihood of headache, encourage your child to:
- Eat three meals a day with healthy snacks in between.
- Drink at least six glasses of water daily.
- Be physically active or exercise at least three times a week.
- Sleep at least eight hours every night.
- Eat a diet rich in fruits and vegetables, with whole grains and lean protein.
Also, keep an eye on how much over-the-counter headache pain medication your child is taking. “We try to limit children who use over-the-counter pain relievers like ibuprofen or acetaminophen to taking them twice a day, two days a week,” Dr. Rothner says.
“If they use over-the-counter pain relievers three to four times a week, for weeks on end, they can get ‘rebound’ headaches that are worse,” he says. Over time, taking too many pain relievers can also cause digestive problems, such as an upset stomach and stomach inflammation, he notes.
Another major part of getting your child to live a healthier, less stressful life includes encouraging open conversation about mental health. “It doesn’t always have to be a medication-first approach when it comes to dealing with stress-induced headaches,” says Dr. Rothner.
Behavioral therapy and guidance from psychologists allow families and children to get to the root of what’s actually causing the child stress. “Finding ways to manage back-to-school worries often starts with open and honest communication,” he adds.
When is it time for a doctor visit?
“Once children start overusing medication or missing too much school (including arriving late and leaving early), these are red flags,” says Dr. Rothner. “They should prompt a visit to your family doctor or pediatrician.”
The same is true if your child’s headaches become more frequent despite practicing healthy lifestyle habits.
If needed, your pediatrician or family doctor can refer your child to a pediatric neurologist or psychologist with expertise in headaches. Good care will help your child manage the “new normal” back at school this fall.