#MigraineClass

Unlocking Academic Success: A Guide to Accommodations for Students with Migraine

By Bernadette Gorczyca

A certified educator, Ed.M.

Migraine is a primary headache disorder affecting up to 7 million children and adolescents in the United States (Brickman & Mondok, 2023). For students living with migraine, the impact can be profound, affecting their ability to focus, learn and thrive in an academic environment.

Recognizing migraine as a disability is the first step toward making sure that your teen with migraine receives the support they need to unlock the same opportunities for academic success as their peers without a disability. In this article, we’ll explore migraine as a disability, the legal rights protecting students with migraine, and clarify the difference between a 504 Plan and an Individualized Education Program (IEP). We’ll also provide a step-by-step guide to help you advocate for your teen’s educational needs so they can access accommodations at school.

Migraine as a Disability

The World Health Organization considers “a day lived with severe migraine as disabling as a day lived with dementia, quadriplegia or acute psychosis and more disabling than blindness, paraplegia, angina or rheumatoid arthritis” (Blumenfeld et al., 2010). This isn’t meant to diminish other diseases but rather to challenge misconceptions that downplay migraine and highlight just how disabling it can be compared to conditions that society readily accepts as disabling.

Migraine is a spectrum disorder, from episodic (fewer than 15 headache days a month) to chronic (more than 15 headache days a month) to intractable (constant). The further along on the migraine spectrum, the greater the level of disability. The impact of migraine-related disability can be assessed using the Migraine Disability Assessment (MIDAS) questionnaire, which measures lost time over the past three months due to migraine (Blumenfeld et al., 2010).

Regardless of the frequency of attacks, migraine is a chronic (i.e., long-lasting) neurological disorder that can significantly affect school attendance, academic performance and overall well-being. Studies have shown that students with migraine experience more frequent absences, lower academic performance, and reduced quality of life in comparison to their peers with other chronic conditions (Turner et al., 2021). This highlights the need for accommodations to support teens with migraine in succeeding at school.

Legal Rights to Educational Accommodations for Migraine

Due to the deeply ingrained societal stigma around migraine, many caregivers, educators and students may be dismissive or even hostile toward accommodation requests for migraine. As a teacher, I witnessed a situation where the head of learning support scoffed at a request for accommodations for a student with migraine. This response was not rooted in bad intentions but rather in a lack of exposure to accurate information about migraine disease. But despite these misconceptions, students with migraine have legal rights to access support. They are protected under laws like the Section 504 of the Rehabilitation Act, Americans with Disabilities Act (ADA), and the Individuals with Disabilities Education Act (IDEA).

Section 504 of the Rehabilitation Act

This law requires schools to provide accommodations that ensure equal access to education for students with disabilities.

Americans with Disabilities Act (ADA)

Like Section 504, the ADA requires schools to provide students with disabilities the accommodations they need to participate in their education fully.

Individuals with Disabilities Education Act (IDEA)

The IDEA provides special education services for students whose disabilities significantly impact their learning. Students with health conditions that strongly impair their learning ability may qualify for an Individualized Education Program (IEP) to receive more specialized support.

Understanding The Difference: 504 plan vs. IEP

A 504 Plan is a formal document that outlines accommodations and support services for students with disabilities, enabling them to succeed in school regardless of disability impact. It may include specific modifications to the learning environment, teaching methods, or support materials. A 504 Plan is intended for students who do not require full special education services but need adjustments to manage their disability effectively in the general education setting. (Protecting Students with Disabilities, 2023)

An IEP is a legally binding document developed for students whose disabilities require formal special education services. Following an evaluation, it outlines personalized accommodations, modifications, educational goals, and related services needed to access a free and appropriate public education. IEPs are reviewed annually and involve collaboration between the school and parents. (What is an Individualized Education Program)

504 Plan vs. IEP for Students with Migraine: What is More Appropriate for Your Teen?

For teens with episodic migraine, a 504 plan is often sufficient, providing the necessary accommodations to manage occasional absences and disruptions to learning due to migraine symptoms. However, for teens with more severe chronic migraine, an IEP may be more appropriate due to the greater level of disability and regular impact on learning. Chronic migraine can cause more persistent issues such as frequent absences, brain fog, cognitive dysfunction, severe pain, gastrointestinal issues, vision problems, anxiety and depression, which require more tailored accommodations. If eligible, students with migraine would be covered under the IDEA category “Other Health Impairment.”

Examples of Accommodations for Migraine:

Access to migraine treatment, such as the Nerivio REN wearable (and their smartphone to start a treatment)*
Access to water and snacks
Flexible scheduling
Excused absences
Modified assignments
Flexible due dates
Frequent breaks
Access to a rest area
Alternate testing location
Permission to use headphones, a hat or migraine glasses

Accommodations should be individualized and tailored to each student’s specific needs. Since migraine is a dynamic disorder, these accommodations should be regularly reviewed and adjusted according to the effectiveness of the student’s migraine management plan.

*Because Nerivio is drug-free, there are no restrictions in class, but each school has its own rules for smartphone use during class time. You can ask your teen’s doctor for a letter explaining the need to use the smartphone in class, in order to treat their attacks with Nerivio.

How to access a 504 plan or IEP: A Step-by-Step Guide by Migraine At School for Parents and Caregivers

Migraine At School is a nonprofit organization dedicated to improving awareness, education, and support for students with migraine. They offer a guide to help parents and caregivers get started with advocating for accommodations in school. Here is an adapted version:

Step 1: Get a migraine diagnosis from a healthcare provider. If your teen has chronic migraine and you are seeking an IEP, consulting with a headache specialist is highly recommended.

Step 2: Have your teen keep a migraine journal to track their attacks, triggers, and symptoms, and treatments. Tracking migraine trends can help you have an informed conversation about the accommodations that will help your teen at school. The Migraine Diary and myAnalytics features in the Nerivio app are useful for tracking migraine frequency, symptoms and treatment sessions.

Step 3: Determine if your teen requires a 504 plan or an IEP.

Step 4: Obtain a letter from a healthcare provider. Migraine at School has a pre-prepared letter that your teen’s healthcare provider can download and fill out. If you are seeking an IEP, it might help to fill out the MIDAS questionnaire for your teen’s headache specialist.

Step 5: Set up a school meeting with your teen’s guidance counselor or the head of student services at their school to establish the need for a 504 plan or IEP. Be prepared with the letter from your healthcare provider, their migraine tracker, and accommodation ideas.

Step 6: Sign up to become a trained Migraine at School Ambassador and encourage your teen’s counselor, learning support teacher, and school nurse to do the same. This initiative focuses on providing de-stigmatized migraine education so students can access better care and management of migraine in a school setting. This will assist you in overcoming any challenges you might encounter while advocating for accommodations for your teen.

Conclusion:

Migraine is a chronic neurological disorder that can greatly impact academic performance and overall well-being for teens. Recognizing migraine as a disability is essential for helping your teen receive the support they need to succeed in school. By advocating for individualized accommodations, you can help your teen navigate school alongside the challenges of migraine disease.

Disclaimer:

The information provided in this article reflects personal experiences and should not be considered medical advice. Please consult with your healthcare provider about your personal migraine treatment plan and to see if Nerivio is right for you.

More Articles from my Back-to-School Series with Nerivio:

Author’s Bio:

Bernadette Gorczyca, Ed.M., is a certified educator with over 13 years of experience teaching in public, private, and international schools. Having lived with migraine since childhood and with chronic migraine since high school, she combines her personal and professional insights to advocate for students with migraine. Bernadette offers virtual tutoring services focused on improving academic outcomes and overall well-being for high school and college students managing migraine and other chronic conditions. Don’t miss out on her valuable migraine resources and support, available through her Instagram and TikTok accounts, @ChronicAccounts.

References:

Blumenfeld, A., Varon, S., Wilcox, T., Buse, D., Kawata, A., Manack, A., Goadsby, P., & Lipton, R. (2010). Disability, HRQOL and resource use among chronic and episodic migraineurs: Results from the international burden of Migraine Study (ibms). Cephalalgia, 31(3), 301–315. https://doi.org/10.1177/0333102410381145

Brickman, L., & Mondok, L. (2023, May). Migraine in Children and Adolescents. Practical Neurology.https://practicalneurology.com/articles/2023-may-june/migraine-in-children-and-adolescents

Migraine in Children. American Migraine Foundation. (2021, April 8). https://americanmigrainefoundation.org/resource-library/migraine-children/

Parents – Migraine at School. Migraine At School. (n.d.). https://www.migraineatschool.org/parents/?gad_source=1&gclid=Cj0KCQjwrKu2BhDkARIsAD7GBov2-q83Ci1CqYuyZr4MnbQ9-NCzwVPAj6hGGfdWWDfb81VBSCeBV9caAibqEALw_wcB

Protecting Students with Disabilities. Home. (2023, July 21). https://www2.ed.gov/about/offices/list/ocr/504faq.html

Turner, S. B., Szperka, C. L., Hershey, A. D., Law, E. F., Palermo, T. M., & Groenewald, C. B. (2021). Association of headache with school functioning among children and adolescents in the United States. JAMA Pediatrics, 175(5), 522. https://doi.org/10.1001/jamapediatrics.2020.5680

What is an Individualized Education Program (IEP)?. Parallel Learning – Special Education Staff Support for Schools. (n.d.). https://www.parallellearning.com/post/what-is-an-individualized-education-program-iep