For families of children and teens living with migraine and headache disorders, going back to school can bring more than the usual mix of new teachers, new schedules and new routines.
It can also mean fluorescent lights, noisy classrooms, missed assignments, rigid attendance policies, limited access to medications or treatment devices, and the difficult question of what happens when a migraine or headache attack begins in the middle of the school day.
For millions of young people, these are real barriers to learning.
Research suggests that approximately 11% of children and adolescents live with migraine, with prevalence increasing as children get older. Headache disorders more broadly are even more common. A systematic review and meta-analysis of pediatric headache prevalence estimated that more than half of children and adolescents experience headache over periods ranging from one month to their lifetime.
Headache disorders can also have a significant impact on school. A nationally representative U.S. study published in JAMA Pediatrics found that children with frequent or severe headache were more likely to experience poor attendance and school-related problems than children without headache. Approximately 17% of children with headache had missed 11 or more days of school during the previous year, compared with about 3% of children without headache.
Migraine can interfere with concentration, reading, vision, communication, memory, movement, and the ability to tolerate light, sound or odors. A student may be physically present in class but unable to process information normally during an attack. They may need to leave class because of nausea or visual symptoms, recover in a quiet space, miss school for medical appointments, or struggle with fatigue and cognitive symptoms after the worst of the pain has passed.
When Migraine Is Misunderstood at School
One of the challenges children and teens with migraine can face is that their disease is not always visible.
A student may look well between attacks. They may earn good grades, participate in sports or activities, and have days when they function normally. During an attack, that same student may be unable to read a screen, tolerate classroom lights, concentrate on a test or remain in school.
That variability can lead to misunderstanding.
Teachers or administrators unfamiliar with migraine may see repeated absences as an attendance problem, interpret difficulty completing work as a lack of effort, or question why a student who seemed fine yesterday needs significant support today. Students may feel pressure to push through symptoms because the seriousness of their disease is not understood.
Migraine is a neurological disease that can be disabling. Its episodic nature does not make its effects less significant.
Federal guidance specifically addressing migraine can help families navigate those conversations.
Students With Migraine Have Rights at School
In December 2024, the U.S. Department of Education’s Office for Civil Rights issued an important resource: Section 504 Protections for Students with Migraine.
The guidance makes clear that a student with migraine can qualify as a student with a disability under Section 504 of the Rehabilitation Act when migraine substantially limits one or more major life activities.
Those activities can include neurological and brain function as well as seeing, speaking, learning, reading, concentrating, thinking and communicating.
Federal disability law also recognizes episodic conditions. A student does not need to experience disabling migraine symptoms every day to qualify for protection. When determining whether an episodic condition substantially limits a major life activity, the condition is considered based on how it affects the person when it is active.
A child should not have to be struggling every day before their needs are taken seriously.
Families who want to learn more can also explore the Department of Education’s broader resources on Section 504 and the Individuals with Disabilities Education Act, or IDEA.
What Can Migraine Accommodations Look Like?
There is no single accommodation plan that is right for every student. Migraine and other headache disorders affect people differently, and accommodations should reflect the individual student’s needs.
The Department of Education’s migraine guidance provides several examples of accommodations that may be appropriate, including:
- adjusting classroom lighting or other environmental triggers
- permission to wear sunglasses or a hat when needed
- alternatives to extended screen use
- access to instructional materials at home when symptoms prevent attendance
- flexibility for migraine-related absences and late arrivals
- the ability to make up missed work without penalty
- rest breaks
- additional time during tests when migraine symptoms interfere
- access to water and snacks
- access to a quiet, darkened place during an attack
- timely access to treatment
These are examples, not an exhaustive list. The right accommodations depend on the student and how their disease affects them.
The Headache Alliance has also developed a Headache-Aware School Checklist to help families, students and schools think through the practical supports that may be needed throughout the school day.
Don’t Forget the Student’s Health Plan
Families may also want to work with the school nurse or other appropriate staff to develop an individualized health plan, emergency action plan or other school health plan, depending on the terminology and procedures used by the school or district.
A health plan can address questions such as:
- Where will the student’s acute medication or treatment device be kept?
- Can the student carry or self-administer medication, or use a prescribed or recommended treatment device, when permitted by school policy and state law?
- How quickly can the student access medication or a device when an attack begins?
- Where can the student go if they need to rest in a dark, quiet environment?
- What symptoms should prompt the school to contact a parent or guardian?
- What should staff do if symptoms become unusually severe or different from the student’s typical migraine attacks?
- Who needs to know about the plan during field trips, extracurricular activities or after-school programs?
Timely access to treatment can be especially important for migraine. A plan that requires a student to wait through multiple layers of permission before accessing medication or a treatment device may delay care when an attack begins.
A health plan can spell out the medical response during the school day. A 504 Plan can address accommodations and access across the student’s educational experience.
Start With Documentation From Your Child’s Health Care Provider
Before the school year begins, consider talking with your child’s pediatrician, neurologist, headache specialist or other treating health care professional about what the student may need at school.
Ask whether they can provide documentation explaining the diagnosis and how the condition affects the student.
Useful documentation may describe:
- the student’s diagnosis
- common symptoms
- the episodic nature of the condition
- how symptoms can affect concentration, vision, reading, communication, attendance or other school activities
- known triggers or environmental factors
- medications or treatment devices the student may need during the school day
- the importance of timely access to treatment
- recommended accommodations or medical supports
The documentation should help the school understand how the disease affects that particular student, rather than simply confirm that a diagnosis exists.
Families should ask their school or district what documentation it requires for medications, treatment devices, health plans, Section 504 evaluations or special education evaluations, since procedures can vary.
A 504 Plan or an IEP?
Families sometimes hear the terms “504 Plan” and “IEP” used interchangeably, but they serve different purposes.
A Section 504 Plan generally focuses on ensuring that a student with a disability has equal access to school and receives the accommodations, aids or services necessary to meet their individual educational needs. You can learn more through the U.S. Department of Education’s Section 504 resources.
Some students whose headache disorder significantly affects their education may also be eligible for special education and related services under the Individuals with Disabilities Education Act and receive an Individualized Education Program, commonly known as an IEP.
IEP eligibility requires more than having a diagnosis. A student must meet IDEA’s eligibility requirements and, because of their disability, need special education and related services. One potential eligibility category for some students with chronic health conditions is “other health impairment.”
Whether a student needs a health plan, a 504 Plan, an IEP or some combination will depend on their individual circumstances.
If migraine or another headache disorder is interfering with a child’s ability to attend school, access instruction or make progress academically, families can ask the school about an evaluation.
Federal Guidance Exists Because Advocates Asked for It
The Department of Education’s migraine guidance grew out of advocacy from the headache community.
During Headache on the Hill in 2023, advocates organized by our sister organization, Alliance for Headache Disorders Advocacy called on Congress to help ensure that students living with migraine and headache disorders were better protected in school.
Former Congresswoman Cori Bush provided important congressional leadership on the issue, working with advocates and other members of Congress to call on the Department of Education to recognize the needs of students living with migraine.
That advocacy helped lead to the Department’s December 2024 guidance specifically addressing Section 504 protections for students with migraine.
The guidance gives students and families something concrete to bring into conversations with schools.
When a parent is told that their child is missing too much school, they can point to federal guidance that specifically addresses migraine-related absences.
When a student needs changes to lighting, screen use or the classroom environment, families can point to federal guidance recognizing those kinds of accommodations.
When someone questions whether an episodic disease can be disabling, families can point to federal civil rights guidance recognizing the impact of a condition when it is active.
Students and parents should not have to convince a school from scratch that migraine can be disabling. THA recommends sharing the guidance document from the Department of Education directly with administrators and teachers to help inform the conversations.
Before the First Bell Rings
Before the school year gets busy, families of children and teens living with migraine or another headache disorder may want to:
- Talk with your child’s health care provider and obtain updated documentation.
- Make sure the school nurse has current medication orders, information about treatment devices, and your child’s treatment plan.
- Ask whether your child should have an individualized health plan or emergency action plan.
- Identify the school’s Section 504 coordinator.
- Review whether an existing 504 Plan or IEP still reflects your child’s needs.
- If your child does not have formal accommodations but needs them, ask the school about the evaluation process.
- Talk with teachers about what migraine looks like for your child, including symptoms that may not be obvious.
- Discuss how migraine-related absences, missed assignments and testing will be handled before an attack occurs.
- Make sure plans extend, when appropriate, to field trips, extracurricular activities and other parts of the school day.
- Involve your child or teen in these conversations whenever possible.
Back-to-School Resources
Know your rights: Section 504 Protections for Students with Migraine
Learn more about federal protections: Section 504 | IDEA
Prepare for the school year: THA’s Headache-Aware School Checklist
Learn about the advocacy behind the guidance: Alliance for Headache Disorders Advocacy
Children and teens living with migraine should be able to get the support they need to learn, participate in school and protect their health.
The right plan will look different for every student. Starting the conversation early, putting supports in writing and making sure school staff understand the disease can make a meaningful difference when the school year begins.
Disclaimer: This information is provided for general educational purposes only and is not intended as medical or legal advice. Individual circumstances, school policies, and state and federal requirements may vary. Families should consult their child’s health care provider about medical needs and a qualified attorney or appropriate school or district representative with questions about legal rights, eligibility, or accommodations.
