It’s August, and lots of my patients getting ready to go off to college, either as freshmen or as sophomores, whose freshman year was spent at home doing college over zoom. It is an exciting and scary time for them (and their parents), especially with the continuing uncertainly of the Covid pandemic. I have had a relationship with many of these kids for years, sometimes since elementary school. Hopefully I have done a good job of educating them, and they have done a good job of listening and learning.
Having headaches is not something that just goes away. The migraines may get less frequent, even disappear for a long time, but the possibility is always there. So people need to learn how to manage their lives in the healthiest way possible.
Since many people start having headaches with the onset of puberty, learning how to manage them starts as a teenager. My emphasis is always on lifestyle, such as:
- Do you sleep enough and have a regular sleep schedule?
- Are you drinking enough water, every day? (you know how much you are supposed to drink… do you really do it?)
- Are you eating regular meals, full of anti-inflammatory whole foods? (we all eat junk sometimes… does the junk outweigh the healthy?)
- Are you exercising several times/week? (are you at least walking the dog?)
- And how about that stress management? Have you downloaded that app I suggested? Or are you still at ‘Netflix and chill’ phase of stress management?
But going off to college presents its own share of issues and challenges. College is the first time that students have a less regimented school schedule, have to share a room, and really have to negotiate life on their own. Hopefully they have learned in the past year how to manage online learning and increased screen time, have some strategies to mitigate the effects. If my teens have adopted a healthy lifestyle and understand their headaches, I feel pretty confident that these challenges will be manageable for them. Once they have the basics as life habits, then they can meet the new challenges with confidence.
I do a fair amount of pre-college lifestyle counseling to get everyone ready. I remind them that unlike most of their peers, they have been challenged by a health issue, managed to succeed despite it, and built some inner resilience that will help them throughout college and beyond. They need to hear that, gives them a bit of perspective and confidence. That resilience will help them negotiate and cope with the ups and downs of college. Things that might set another student off, they will be better able to take it in stride. They have perspective and have met adversity that others have not, which will lead to more positive outcomes.
I talk about alcohol, drugs and personal safety, as it pertains to headache (and sneak in other comments as well).
Alcohol: I don’t condone or encourage drinking but do acknowledge that it is a reality at college. They will be presented with those situations and need to think ahead about how to deal with it. They can choose to drink or choose to hold a red cup and not drink. I let them know that white wine is better than red (from a migraine perspective), lighter in color is better than darker in color; for every alcoholic beverage they drink, they have to follow it with water, because alcohol will dehydrate you, leading to headache/migraine. And before bed, they need to drink a large water or Gatorade. This advice will hopefully help with preventing headache, and also help manage to decrease consumption.
Drugs: The big one for college is marijuana. Our party line is that marijuana interferes with brain development, which is at its peak during the high school and college years. This is your prime time for learning, why do something that can limit your potential. In teens with lots of anxiety, marijuana can also trigger psychosis. I have nothing personal against marijuana, but just wait until you are 25 to indulge.
Personal safety: the majority of my patients are female, this is a big deal for me. We talk about going to parties with a friend, agreeing to watch out for each other, guard their beverages, keeping a hand over the top of the cup to prevent being drugged, etc. I stress that alcohol reduces their ability to make good and safe choices; that they should be watching out for others, be brave and step in when you sense danger for another woman. That young woman might be mad at you at the time, but you may have prevented an assault, and they would be grateful. I wish I did not ever have to talk about these things, but unfortunately, I have had more than one young female college student come in and tell me about how they were sexually assaulted on campus, and alcohol was involved. It breaks my heart.
We also talk about self-care on campus. Most schools have some ‘wellness’ opportunities available, such as counseling, yoga, meditation groups, tai chi, therapy dogs, etc. I encourage them to try everything at least once. When else are going to try out something new that is readily available to them? It is especially important to know about the counseling resources on campus, any limits on visits, etc. Campus counseling can be a godsend in a crisis. It is an anxiety-provoking time at baseline but in the time of pandemic, there are more worries than ever. Social isolation was a concern last year, and depending on the campus, it may be again this year.
There also might be a tutoring or study skills center that can help with time management. It’s a new world for them and they have to learn to negotiate it. Figuring out when to study vs go to the gym vs take a nap is an important step in gaining independence and mastery. Managing life and decisions is one of the important skills to learn for the college student/young adult.
So September is fast approaching and the kids are going off to college. I feel pretty good about most of them, they should do well. I will see many around the holidays for a check in and will get to hear all about it- the good and bad (roommate drama!). We’ll strategize about the challenges and celebrate the victories. I wish them all to stay well, stay safe, and enjoy this unique time in their lives.
HeadFirst PNP 