From the Clinic to the District: Building Systems for Youth with Migraine

By Scott B. Turner, DNP, APRN, FNP-C, FAHS, University of Alabama at Birmingham and Kaitlin A. Greene, MD, Oregon Health & Science University
 

In our recent article, “Taking the LEAD in headache advocacy: Focus on migraine at school,” we highlight the American Headache Society’s (AHS) investment in Leadership in Advocacy Development (LEAD) for mid-career physicians and advanced practice providers. As members of the LEAD program’s first two cohorts, we have both focused our efforts on improving the recognition, treatment, and support of youth with migraine in the school setting.

Dr. Turner set out to replicate the Headache Action Plan Project for Youth (HAPPY) (Connelly et al., 2018) in a rural and an urban underserved community in central Alabama. He partnered with a Federally Qualified Health Center (FQHC) with primary care and advanced practice provider residency programs, delivered the AHS First Contact - Pediatrics lecture to the providers, and worked with administrators to track migraine diagnoses through ICD-10 coding. That effort revealed a gap in the data: only the primary diagnosis for each visit could be identified, and often it was not headache-related. Dr. Turner also reached more than 500 school nurses through a one-hour webinar and staffed a Migraine at School table at the Alabama Association of School Nurses Conference. Eight nurses expressed interest in working on a migraine project at their schools, but none were able to get institutional support to proceed. These are systems barriers, not a lack of will: clinic documentation that captures only the primary diagnosis, and schools with no formal pathway for nurses to act on migraine once identified. 

Dr. Greene’s project is focused on continuing to identify barriers faced by students with migraine, including inconsistent school accommodations. Migraine can contribute to both poor performance in school and school absenteeism. Students with migraine are eligible for educational accommodations under Section 504 of the Rehabilitation Act of 1973, and many providers attempt to support students by recommending that schools provide adequate educational accommodations. However, a recent review she co-authored found little evidence supporting the efficacy of these strategies (Turnage et al., 2025). As a result, the accommodations suggested by providers often vary, creating a systems barrier by leaving schools to interpret inconsistent requests. Dr. Greene’s current work aims to build expert consensus on, and harmonize, specialty-generated school-based accommodations under Section 504.

There is a tremendous need to promptly identify youth with migraine and provide them with an effective treatment plan for home and school. A 2025 AHS position statement recommends annual migraine screening as a standard of care for women and girls beginning at puberty (Schwedt et al., 2025), and schools offer a natural setting for screening all students. School nurses are well positioned to lead this work. They can identify students with migraine using a screening tool such as the Pediatric and Adolescent Migraine Screen (PAMS), share Migraine at School resources with those who screen positive, and ask families to see their pediatrician and return a completed Pediatric Migraine Action Plan (PedMAP) (Turner et al., 2019).

Systems-based solutions will move this work from the clinic to the district. When school district policy aligns the PedMAP with asthma, allergy, and seizure action plans, nurses will be empowered to screen, identify, educate, and guide a child and their family toward early diagnosis and effective care with their pediatrician. Expert consensus on school-based accommodations under Section 504 or other school-based plans would give schools clear, evidence-based guidance on how to best support students with migraine. With nearly 7 million children and adolescents in the United States living with migraine (Brickman & Mondok, 2023), it will take a strong coalition of clinicians, patient advocacy groups, school nurses, and school administrators to meet this need.

References

1. Brickman L, Mondok L. Migraine in children and adolescents. Pract Neurol. May/June 2023. https://practicalneurology.com/articles/2023-may-june/migraine-in-children-and-adolescents
2. Connelly M, Bickel J, Wingert T, Galemore C. The Headache Action Plan Project for Youth (HAPPY): School nurses as facilitators of system change in pediatric migraine care. NASN Sch Nurse. 2018;33(1):40-47. doi:10.1177/1942602X17719300
3. Greene K, Turner SB. Taking the LEAD in headache advocacy: Focus on migraine at school. Headache. Published online October 8, 2026. doi:10.1111/head.70239
4. Schwedt TJ, Starling AJ, Ailani J, et al. Routine migraine screening as a standard of care for women’s health: A position statement from the American Headache Society. Headache. 2026;66:511-516. doi:10.1111/head.70023
5. Turnage C, Balmaseda A, Greene K, Leininger A, Heierle J. Supporting students with migraine: Examining current practices and identifying strategies for educational success. Curr Pain Headache Rep. 2025;29(1). doi:10.1007/s11916-025-01425-9
6. Turner SB, Rende EK, Pezzuto T, et al. Pediatric Migraine Action Plan (PedMAP). Headache. 2019;59(10):1871-1873. doi:10.1111/head.13681