Table 3.

Guidance for Caregivers of Children with Headaches to Support Emotional Health and Minimize Stress as a Headache Trigger during COVID-19 Pandemic

Domain	Caregivers are encouraged to:
Engage in Parental Self Care	Identify the areas in which the caregiver her/himself may be struggling with the pandemic (e.g., anxiety, social isolation). Engage in “coping behaviors” (e.g., exercising, journaling, taking deep breaths) and seek support as needed. Children can be affected by parental stress.
Model Emotional and Physical Health Behaviors	(A) Discuss the above coping mechanisms with children to demonstrate the value of self-care. (B) Model social distancing, wearing a mask, and washing hands in a calm and consistent manner.
Provide Emotional Support	(A) Normalize and validate the child’s experience while encouraging open communication regarding thoughts, feelings and worries with returning to school50. Pair empathy with encouragement: “I know this is scary, and I know you can do it!” (B) Help the child identify a “menu” of coping skills (e.g., 10 deep breaths, drawing, taking a short mask or water/snack break at school). (C) Explain the specific changes in school (e.g., wearing masks, limiting time in school) and the impact your child has on maintaining safety for her/his peers, staff and their families to create a sense of empowerment. (D) Support the child in gradually engaging in anxiety provoking activities to help them habituate, or become used to, the activities (e.g., wearing masks around the home while engaging in enjoyed activities)100.
Create Structure	(A) Consider ways to organize the child’s daily and weekly school responsibilities to remain caught up on schoolwork and minimize the potential of increased stress that could trigger a headache attack and/or interfere with sleep schedule and mood. (B) Discuss details of the school’s current plan (e.g., schedule for online coursework) and secondary plan (e.g., what a planned hybrid model might look like). (C) Create a “COVID Kit” of materials that will help the child at school (e.g., an extra mask, extra pens, hand sanitizer). (D) Develop a plan for quarantine procedures in the event of exposure. Where will your child stay? How will they receive meals and medical care in this time?
Advocate with School	(A) Connect with the school community and identify specific school staff that the child can contact should they experience a migraine attack or need extra support. (B) Consider requesting a meeting with identified teachers, school counselor and nurse to discuss a medical plan and supports for your child. (C) For children with existing 504 or IEP plans, place a request to the school in writing to modify accommodations to the current school environment. Special education laws and regulations are not waived during the pandemic101.
Seek Support	(A) Remind the child that experiencing anxiety at this time is normal and expected. Worries about exposure to the virus or getting others sick can help motivate protective behaviors (wearing a mask, washing hands). (B) If these behaviors and worries begin to interfere with typical functioning, contact a behavioral health provide for increased support.