Moving into adulthood

Working in pediatrics means guiding our patients from childhood to adolescence to adulthood. This is usually a natural progression, based on society’s norms and our schooling systems. It is an exciting and scary time for our children and for their parents.

Having headaches and migraines is not something that just goes away once your child becomes a young adult. Migraine may get less frequent, even disappear for a long time, but the possibility is always there throughout the lifespan. New daily persistent headache may resolve but the person may be more prone to headaches or migraine throughout life. Most people experience tension-type/stress headaches at times. Your young adult will need to learn how to manage their lives in the healthiest way possible. Hopefully, the emphasis of headache care has been on prevention and treatment, including leading a headache-healthy lifestyle, in preparation for the rest of their lives.

Basic headache management for the young adult should be focused on the same elements as when they were younger. Now that they are older and presumably more mature, the responsibility for keeping on track falls on the young adult, rather than the parents. If they really were able to internalize these healthy habits, they will have an easier time moving forward into adulthood. Focus continues to be placed on: sleep, hydration, healthy diet, exercise and stress management. While many students continue their education with college or additional training programs, many young adults do not, and enter the working world.

Workplace concerns: We know that migraine is a frequent health issue, nearly 1 in 4 people suffer from this condition, and many of them work outside the home. Attendance at work is even more important than in school. Migraine stigma is a real issue. Missing work because of migraine is often disparaged as ‘not real’ or ‘an excuse’. In fact many people either go to work if they can while suffering a migraine (being present) or call out sick from some other illness, rather than say they have a migraine. Unfortunately, migraine is the leading cause of disability in people under 50, and is a worldwide problem. Living a headache-healthy lifestyle, with healthy habits and effective stress management is the key to success for everyone with migraine and chronic headache.

There is an excellent online resource called migraine at work (migraineatwork.org) which helps those with headache and migraine to manage in the work place. There is good information about work accommodations, legal rights of employees and employers, downloadable forms. Attending a chronic headache/migraine support group, virtual or in-person, can be a source of information and support to those trying to thrive in the workplace. This organization has a presence on Instagram and LinkedIn. I just recently referred one of my patients to their site for resources to ensure a stigma-free and healthy workplace.

Transitioning to Adult headache care: In most pediatric practices, there are age limits for continuing care, between ages 18 to 26. Moving on to adult care feels natural as the person is starting their adult life. They may be relocating, getting a ‘real’ job, or more schooling.

There are many people with migraine or headache who do not need ongoing headache-specific care. If they are on a common preventive medication, or common rescue medications, their PCP/adult internist can easily prescribe these medications. Transition to an adult headache or pain program is needed for person with ongoing and difficult headache management, and those who regularly undergo procedures such as Botox® for chronic migraine, nerve blockade, or infusions. People with chronic daily headache, chronic migraine or NDPH, would be best served by transferring care to an adult headache management program. If there is not a dedicated headache program, they need to investigate what would best meet their headache needs- an adult neurologist or adult pain program. Call around and ask if the program can provide the services that are really needed, which can be through a headache or pain program, or an adult neurologist with headache specialty.

Other Considerations: It is important for the young adult thinking about relocating to know the resources in that area. Are they moving to a place with a university-based pain or headache program? If not, are there resources for obtaining advanced headache care if they need it? Are there alternative and complementary practitioners or psychological providers in the area? Think about the climate or weather. Many people with headache are reactive to weather patterns. If heat and humidity is a problem, perhaps do not move to Florida.

Finally, helping a young adult move into adult care will take time, often 1 year to get the services needed. Start talking about this sooner rather than later, especially if the young adult needs advanced care. In my clinic, we start the talk and encourage making the first appointment, which often can be 6-9 months away. We care for the young adults until they are able to move on. It is a pleasure to see a young adult patient able to move forward to full adulthood, taking responsibility for their health and able to access care.