Your patient has passed the next step, by graduating from high school. They have chosen their next path- going to college. They are so pleased to tell you all about it, and you are so proud of them. This is also a time of both positive and negative stress. Perhaps high school was really hard for them academically, socially and/or emotionally. They needed and used accommodations around school work and attendance. They needed you to write letters for them, perhaps talk with the school nurse or guidance counselor. But they made it! They are out of the woods, or so they think.
Well, just because high school is over, that does not mean the challenges to someone with migraine or chronic headache are over. There will still be academic requirements that need to meet, challenges to face, social situations to navigate, lots of hurdles. Generally speaking, those who needed accommodations in high school will continue to need them in college. (There are also considerations for those moving into the working world as well, a subject for another post.)
Here is where you, their provider, can help.
First, have a frank talk about how they are actually doing in terms of functionality. How much school did they miss? How often did they need to use extra time to complete assignments or to complete exams? Were they able to active in extracurricular activities, sports, or music, and with friends? Whatever accommodation they had in HS, they should have access to in college. If they just needed extra time occasionally because a migraine interfered with getting a project done, then the odds are they will be OK with the current accommodations and plans.
But what if they needed a lot of excused absences, extra time, missed many days, had many late arrivals or early dismissals around school, showed a good amount of functional disability? Your patient and their family really need to think about the reality of the current plan. Is going to a school far from home, living on campus with a roommate for the first time, navigating the campus environment really going to work for them? Most of the time, in my experience, they do find a way. But sometimes, the student is not really going to be able to make it work, in the traditional way. Discussing the options- part-time college attendance, going to a local community college for a few years or perhaps doing a virtual option- can ease the transition. I like to frame it as achieving their personal academic goals in their own time for a positive outcome. How they do this does not have to look like what everyone else does. This often means readjusting expectations for both student and parents. But it is better to take a bit longer to get to the destination with adjustments along the way, than deal with multiple, often costly, detours which end with a negative outcome. You hope they are set up for success, rather than failure.
Second, what are appropriate college academic accommodations to request? If your patient have a 504 or IEP in high school, they are able to obtain the same in college. Both public and private colleges in the US have to offer students with disabilities (medical, learning) reasonable accommodations for equal educational opportunities, according to the Americans with Disabilities Act.
Appropriate accommodations for students with migraine or chronic headaches include:
- Extra time to complete assignments and examinations if necessary
- Excused absences from class at times of severe headache or migraine
- If requested, access to a quiet room to complete examinations
- No more than one examination daily if possible
- Preferential course selection- ability to choose classes before the general population to manage their schedules
Advise your patient to contact the college or look at the website to find out the process for obtaining accommodations. It might be a good idea to check this out before they make their final decision. The office on campus is often called the disabilities or accessibility or even wellness office. They may have their own form to be filled out by the student and the provider, or may just ask for a letter on clinic/institution letterhead.
I ask them to decide if they want to continue their accommodations as soon as they are admitted. Then find out how to request what they want. Then contact our office as soon as possible for whatever supporting documentation they need, as well as what accommodations they actually want. Usually academic accommodations that match what they already had in HS is not a problem at all. But the process needs to be done in a timely manner. Don’t come to me in August with the request that you need fulfilled in a few days, as you will be disappointed!
Housing accommodations are another issue altogether and usually harder to get. But if they really need a single room, better to ask up front early for best results. There is a separate housing office which handles this and there are always forms to fill out.
For a single room, the reasoning is the need for the ability to control environmental stimulation. Having a roommate can make it difficult for someone with chronic headache/migraine to manage things like lighting, noise, smells, sleep/wake needs, room temperature. The social aspects of having a roommate should also be considered, as it potentially allows the student more opportunities to make friends and be involved with campus life. Many of my patients, if they have a roommate, do their best to be considerate of them and not to impose too many restrictions, if possible. Sometimes this works quite well. But roommate drama is a real thing and can totally derail someone’s freshman year.
Here’s an example of documentation for someone with both chronic migraine and chronic pain:
Functional limitations: at times of migraine or increased pain, ST may need to miss classes, and postpone getting their school assignments and readings done. ST will need to take their rescue medications and rest/sleep in a cool dark room for their pain and symptoms to resolve. Triggers for migraine are environmental heat and stimuli (bright light, loud noise, strong smells), weather changes, stress, and dehydration. ST may experience increased joint pain in association with increased physical activity.
Accommodations requested, to preserve function despite chronic pain conditions:
- Extra time to complete assignments and examinations if necessary
- Access to a quiet room to complete examinations
- No more than one examination daily if possible
- Preferential course selection
- Excused absences from class at times of severe headache/pain without penalty
- Single room on the main campus with access to an elevator and air conditioning. This will enable ST to control their environment for optimal functioning while having a migraine or pain flare, allow ST to be able to ambulate effectively to their classes without increased fatigue or increased pain.
Most students and their families want a successful transition to the next phase in life after high school. We can help them with realistic conversations and observations, and of course, filling out the inevitable forms.
HeadFirst PNP 