It’s the very end of the school year, summer is fast approaching. What does that mean for pediatric headache providers? Hopefully there will be fewer distress calls. It also means numerous camp medication forms and 504 support letters for the fall. Importantly, there are less hectic days with more time to reflect on the general running of the clinic, innovations and research ideas.
For patients with headache, summer also means special attention to the effect of heat and humidity, and environmental instability (thunderstorms). It means less stress for families around school. It means less structure which for some patients is important in keeping up their headache-healthy habits. I often switch my messaging during the summer to focus on maintaining good habits, despite less structure.
Hydration is definitely one thing that can fall off, if they are not mindful about it. During school it is easier to stay on course; you drink before school, carry a water bottle and drink it empty before the end of the day, refill when you get home. That is generally a recipe for success around baseline hydration. During the summer, trying to maintain that routine is harder, but really even more important. Heat and humidity are often triggers for migraineurs, and dehydration can trigger any kind of headache. Staying really hydrated can help. I usually suggest that they include electrolyte-rich fluids daily during the summer, at least when they are going to be out and active, and to add an extra 20oz to their baseline requirement. Good sources of electrolyte-rich fluids are drinks like Gatorade, but also add-ins can be even more convenient, like electrolyte powders and my favorite, Drip drop (contains sodium and potassium, magnesium and zinc). They can carry these in their backpack or mom’s purse and just add to water whenever needed. There are some fun ways to rehydrate in summer, like popsicles (and who doesn’t like popsicles?) I recommend baseline hydration is their weight in kg in ounces (50kg=50oz/day) or ½ their weight in lbs.
Speaking of heat, many kids with headaches are very sensitive to environmental heat and humidity. Going to camp can be a challenge if there are no ‘cooling stations’ available (something to be checked out before sending them off to sleep away camp for 6 weeks). Being proactive, paying attention to the weather can help avoid the migraine that happens during hot times. Going to the beach or the park, it would be helpful to have some ice packs in the cooler to use on hot foreheads and necks; better yet are damp, frozen hand towels that they can wrap around their heads (wet and then freeze, can stay cold for a while). It is way for parents to be prepared for the almost inevitable hot weather migraine.
Of course, too much sun exposure causing sunburn or sun poisoning is a concern, but so it the challenge of bright sunlight (think of the blinding sun at the beach reflecting off the sand). So the usual sunglasses might not be enough to prevent a migraine. The kids might need extra dark sunglasses, polarized lenses, and to wear a wide-brimmed hat to avoid overexposure to bright sun. I usually recommend sun darkening lenses for their regular glasses, which are helpful all year round, transitioning from inside to outside.
Another concern for the summer: amusement parks. So much fun! So many rides! So much spinning! So much noise! So much migraine & headache-inducing stimuli! Families do need to consider the risk/benefit ratio of the annual trip to 6 Flags (hours of fun vs. hours of headache). Being prepared is key- so many kids with headache are very prone to motion sickness. Premedication can be a lifesaver and there are many options. The stand-by antihistamines (dramamine, meclizine) work well but often leave kids drowsy. Using other types of methods, like Seaband wrist bands, ginger chews or gingerale/beer, and the homeopathic Hyland’s motion sickness remedy are useful and don’t decrease alertness. Strategic rest breaks in the shade, lots of hydration, and cooling off in the pool are just a few ways to keep the fun times going.
So enough about the summer hazards! It is also a great time of the year for enjoyment. Summer means more sleep, less stress, and the opportunity to be outside in nature. In general, kids love to be outside, doing so many fun activities, like bike-riding, swimming, kayaking, rock climbing, and so on. It is so good for their headache-health and general health. It’s also good for their provider’s health and outlook.
It also means I get to see my college students- yeah! I love when they come in and tell me how well they did, not so much academically, but socially and with their self-care. Most of them I have known and coached through their high school years, and it is great to see them putting advise into action. Some do struggle but with guidance, most will do well. Watching teens move into adulthood is gratifying.
So that’s it, wishing you all an enjoyable less stressful summer. Here in the Northeast, summer is so short, we grab that time with enthusiasm and joy.
HeadFirst PNP 