We are not simply treating one child in isolation; we are also dealing with the parents, siblings, and the school. The primary “caretaker” parent (usually mom) ranges from psychiatrically normal to a severe personality disorder. Long-term outcomes with these kids somewhat depends upon the psychiatric health of the parent. The child’s psychiatric status is also a crucial variable. It “takes a village” to raise some of these kids, and we recruit “other villagers.” These include psychotherapists, physical therapists, biofeedback specialists, etc.

Adolescent psychotherapists are invaluable. They often provide the most useful therapy for the child. Many will take a family therapy approach. Family dynamics play a crucial role in perpetuating refractory headaches. Also, the patient’s severe headaches adversely affects the rest of the family. Many of the kids are not ready for high school, with tremendous fears and anxieties. After a number of therapy sessions, the therapist often has a good grasp as to why the child has severe headaches, along with school avoidance. For some kids, the long-term relationship with the psychotherapist may be the most important element of treatment.

Many kids do need tough love, and to be pushed to go to school. Others do best with home schooling or homebound, online education, modified school (limited hours in class), or a hybrid. In one study, home-schooled kids with headaches did reasonably well academically, but they did wish for more social interactions during the day. Adolescents on homebound often experience severe anxiety, and not attending school helps the social anxiety. Each child’s needs differ. Not all schools are flexible, and alternative programs may not be available.

When a homebound child returns, it is helpful to ease back into school. I will usually write letters recommending late starts, early release, no gym, etc, – whatever helps. If the adolescent will at least go back part time, I will do my part and help to facilitate the return to school. This works for some of the kids.


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