It’s getting close to that time of the school year. Your teenage patient with chronic headache/migraine is finishing up their high school education, either through the traditional or non-traditional pathway. They have chosen their next step—going to college. As their provider, you are so proud of them. Perhaps high school has been really hard for them academically, socially, and/or emotionally. They needed and used accommodations around schoolwork and attendance. They needed lots of support.

Well, just because high school is over, it does not mean the challenges to someone with chronic headache/migraine are over. There will still be academic requirements to meet, challenges to face, social situations to navigate, and lots of hurdles. Generally speaking, those who needed accommodations in high school will continue to need them in college.

As their provider, you can help bring reality to hoped-for expectations. You can have a frank talk about how they are actually functioning and the challenges of college life—academics and social. Explore how much they really needed their accommodations: how much school did they miss, how often did they need extended time to complete assignments, and were they able to participate in other activities? An honest assessment can guide your student to being realistic about what they will be able to achieve in the college setting and how to reach graduation.

They will need to think about their chosen college setting, academic course load, housing situation, and ability to participate in extracurricular activities. This often means adjusting expectations for both students and their parents to avoid costly detours and negative outcomes. Maybe they need to attend part-time, live at home, or enroll in a community college to ensure success at the start. You encourage them to choose wisely to achieve success rather than failure.

Once the decision is made, the next step is to find out how to apply for appropriate academic accommodations. If your patient had a 504 or IEP in high school, they can obtain the same supports in college without too much hassle. Both public and private colleges in the U.S. have to offer students with disabilities (medical, learning) reasonable accommodations for equal educational opportunities, according to the Americans with Disabilities Act. Advise your patient to find out the process for obtaining accommodations, any deadlines, any forms needed, and who needs to fill them out. They also need to assess the level of campus support available through counseling, disability services, or wellness offices.

Appropriate accommodations for students with chronic headaches or migraine include:

• Extra time to complete assignments and examinations if necessary
• Excused absences from class at times of severe headache or migraine
• If requested, access to a quiet room to complete examinations
• No more than one examination daily, if possible
• Preferential course selection—the ability to choose classes before the general population to manage their schedules

Housing accommodations are usually harder to get and handled in the housing office. There are always forms to fill out. The students need to be very mindful of deadlines and ask early for what they need. They also need to be realistic about what the college can actually provide. If the college has limited on-campus housing, few single rooms, or no elevators, then it might be hard for a specific accommodation to be provided. It’s a good idea to check this out before committing to a college.

There are pros and cons to asking for a single room. The benefit can be the ability to control environmental stimulation, such as lighting, noise, smells, sleep/wake needs, and room temperature. However, the social aspects of having a roommate need to be considered, as it potentially allows the student more opportunities to make friends and be involved with campus life. There is no real predicting how it will work out with sharing a space, but roommate drama can totally derail someone’s freshman year. For many students, this is their first time having to share a room and negotiate what they need.

As a provider for teens with chronic headache/migraine, these issues and requests come up frequently, especially in spring and summer. Most students and their families want a successful transition to the next phase in life after high school. We can help them with realistic conversations and observations and, of course, filling out the inevitable forms.

Vickie Karian is a pediatric nurse practitioner.