Migraines

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I have a student this year with brain CA. I know he wants to test us and see how we respond, but he comes in almost every day. He says he has a migraine, meanwhile he wants the glaring lights on and his mouth is going like a duck's tail feathers. I realize chronic conditions present different than acute, but these things don't coincide with what I expect. I don't want to blow off his symptoms, but he get Mountain Dews and GatorAde when he has a headache.

Specializes in Critical Care.
Thanks for the input, I really value your opinions. I totally understand that the soda is for the caffeine, I'm OK with it, really, but that gives him one more positive consequence to being in my office. He has a slow growing low grade Astrocytoma. He talks a lot from the victim standpoint where he has endured a lot. I don't discredit that viewpoint, but I believe one can get further by not staying there. Had a 5 minute conversation with mom and dad, so hard to gauge where they are with this. My principal thinks a meeting with mom and dad is in order.

I'm not a cancer expert, but I thought astrocytoma is the worst form of brain cancers and most victims die within a couple years. Isn't this the cancer that Senator McCain is currently struggling with? You sound cold and unsympathetic that he has a victim mentality. How is he supposed to deal with a almost assuredly fatal cancer diagnosis! I'm offended just reading your comments!

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Specializes in Pedi.
I'm not a cancer expert, but I thought astrocytoma is the worst form of brain cancers and most victims die within a couple years. Isn't this the cancer that Senator McCain is currently struggling with? You sound cold and unsympathetic that he has a victim mentality. How is he supposed to deal with a almost assuredly fatal cancer diagnosis! I'm offended just reading your comments!

There are 4 WHO grades of astrocytoma. A grade IV astrocytoma, also known as a glioblastoma multiforme, is what John McCain has. Most children have low grade astrocytomas, grade I or II, and most will survive long-term.

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Specializes in Critical care, Trauma.

Not a school nurse here, so I might be completely in left field.....but, if the kid is able to tolerate the bright lights and is talking like someone that's not particularly bothered by his migraine, then why does he need to come see you? Is it not reasonable to say "you seem to be managing well" and send him back to class? Aside from the caffeine from the soda, the novelty of having a go-to excuse to step out of class, and the time to chat with you, is there something else he is he getting out of this? Is he just sitting there, drinking and chatting? Does he get sent home each day?

Maybe he's having a migraine and it's just not that bad (we've all seen someone with terrible migraine symptoms, you cannot ignore them) or maybe he's not actually in pain. Either way, it sounds from your description that you are right in your assessment that he's being reinforced in this behavior and it's getting manipulative and a bit out of hand. Again, I'm not a school nurse nor do I work with kids so I'm interested to hear the opinions of others that have more experience in this area.

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Specializes in Pediatrics Retired.
Not a school nurse here, so I might be completely in left field.....but, if the kid is able to tolerate the bright lights and is talking like someone that's not particularly bothered by his migraine, then why does he need to come see you? Is it not reasonable to say "you seem to be managing well" and send him back to class? Aside from the caffeine from the soda, the novelty of having a go-to excuse to step out of class, and the time to chat with you, is there something else he is he getting out of this? Is he just sitting there, drinking and chatting? Does he get sent home each day?

Maybe he's having a migraine and it's just not that bad (we've all seen someone with terrible migraine symptoms, you cannot ignore them) or maybe he's not actually in pain. Either way, it sounds from your description that you are right in your assessment that he's being reinforced in this behavior and it's getting manipulative and a bit out of hand. Again, I'm not a school nurse nor do I work with kids so I'm interested to hear the opinions of others that have more experience in this area.

Quite astute and right on with your post. The issue we deal with in the school setting is the dynamics of the parents. On one end of the spectrum is a parent who "gets it" and wants the child to adapt and immerse themselves into every routine and normal involvement there is, intervene when necessary and stand back otherwise. On the other end of the spectrum is the parent who is a munchausen variant and using the child to fulfill whatever emotional need they, the parent, is lacking. In between is every other parent dynamic degree imaginable and that is the trick...ID, assess, and intervene in a manner which offers the best advocacy for the student. Sometimes you're the windshield and sometimes you're the bug. We do the best we can and hope and pray the child benefits in the end.

I appreciate your thoughtful and objective input.

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Specializes in Adult Internal Medicine.

Why are non-migraine type headaches being treated with caffeine? If he was getting an APAP instead of a Mt. Dew maybe that would help fix the problem?

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Specializes in Clinical Research, Outpt Women's Health.
I'm not a cancer expert, but I thought astrocytoma is the worst form of brain cancers and most victims die within a couple years. Isn't this the cancer that Senator McCain is currently struggling with? You sound cold and unsympathetic that he has a victim mentality. How is he supposed to deal with a almost assuredly fatal cancer diagnosis! I'm offended just reading your comments!

I think you are meaning Glioblastoma.

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Specializes in Pediatrics Retired.
Why are non-migraine type headaches being treated with caffeine? If he was getting an APAP instead of a Mt. Dew maybe that would help fix the problem?

The elephant standing in the room, according to the subjective versus objective data being gathered by Mr, is this post really has nothing to do with headaches and proper treatment of any particular type of headache and everything to do with behavior and rewards for such behavior.

In other words, if Mr received an order to treat this kid's headache at school with a serving of liver and onions, it's likely the complaint would disappear.

But...there is no proof positive, hence, dancing around the periphery of possibilities.

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Specializes in IMC, school nursing.
Why are non-migraine type headaches being treated with caffeine? If he was getting an APAP instead of a Mt. Dew maybe that would help fix the problem?

He has Maxalt. Motrin and Tylenol for pharmaceutical treatment, but I prefer non med treatment, which seem to be adequate.

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Specializes in IMC, school nursing.

In other words, if Mr received an order to treat this kid's headache at school with a serving of liver and onions, it's likely the complaint would disappear.

I think I will be making a phone call.

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Specializes in IMC, school nursing.
I'm not a cancer expert, but I thought astrocytoma is the worst form of brain cancers and most victims die within a couple years. Isn't this the cancer that Senator McCain is currently struggling with? You sound cold and unsympathetic that he has a victim mentality. How is he supposed to deal with a almost assuredly fatal cancer diagnosis! I'm offended just reading your comments!

I understand where that could be the interpretation. I was told at the beginning of the year that this is considered "benign" as it is slow growing and curable per the parents. I am an advocate for my students and patients in my other role. This is my primary career choice, chosen at age 12 when society viewed all male nurses as gay. Sometimes I see nurses make these accusations of lack of compassion as a bullying tactic and truly, I am asking you to contemplate this when you choose to make these assumptions. AN is full of nasty nurses, let's try to make it a little nicer.

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Specializes in Adult Internal Medicine.
He has Maxalt. Motrin and Tylenol for pharmaceutical treatment, but I prefer non med treatment, which seem to be adequate.

As a caveat, I am not a school nurse and never have been, so really I have very little expertise.

From the other side of the phone, as a provider, I would want to be getting a phone call about this kid. my unsolicited two cents/though process:

1. If kiddo is actually having migraine-type headaches, daily, he needs to be seen and evaluated for prophylaxis.

2. If kiddo is not having migraine-type headache but rather another type of headache, especially with his dx, he should be seen and evaluated.

3. If kiddo is not having headaches at all but using it as an excuse, he should be seen and evaluated for psychosocial stress/abuse.

In any form, it sounds like something needs to be done.

Pardon my intrusion into the school nurse world.

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Specializes in Pediatrics Retired.
As a caveat, I am not a school nurse and never have been, so really I have very little expertise.

From the other side of the phone, as a provider, I would want to be getting a phone call about this kid. my unsolicited two cents/though process:

Pardon my intrusion into the school nurse world.

No need for pardon...other observations, thoughts, and opinions are always welcome. Thank You.

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