Share
Headache home monitoring improves patient care
Headaches are common among children and teens. Those who have chronic migraines, however, are best treated with close monitoring by headache specialists to minimize school absences and other disruptions to everyday living.
“These kids are dealing with painful attacks and different symptoms. They’re missing a lot of school days,” explained child neurologist Reena Rastogi, MD, clinical director of the Pediatric Headache Clinic at Barrow Neurological Institute at Phoenix Children’s, one of the largest headache in the country.
Headaches impact school and daily living
“There are different types of headaches, and migraine is a very common subtype. Patients with chronic migraine have attacks on15 or more days a month,” said Dr. Rastogi. “Migraine is the type of headache where it’s hard to do routine activities you would normally do. During a migraine, most people have to stop and rest, sometimes even taking a nap. And migraines associated with certain other symptoms such as nausea, sometimes vomiting, and sensitivity to light and sound.”
Dr. Rastogi and her colleagues saw an opportunity to improve care for patients with chronic migraine. They developed Headache home monitoring to keep close tabs on how patients are responding to preventive medications and other treatments, rather than waiting months for the patient’s next follow-up visit with a neurologist.
Easy-to-use home monitoring survey allows a prompt response
Launched in August 2024, headache home monitoring is helping dozens of families. Neurology team members identify the best candidates to monitor, typically newly diagnosed migraine patients. Once enrolled in home monitoring, the child’s parent gets a link to a survey via text message once a week.
The parent or patient respond to eight questions, and physicians receive the responses. A few of the questions include how many days the child had a migraine that week, how many school days were missed, what medication was used and if the child had any side effects.
“We’re able to see fairly quickly how the last week went for the patient,” Dr. Rastogi said. “Our home monitoring survey allows close contact with the child regarding their response to treatment. The goal is to improve engagement and real-time communication with families.”
Physicians get alerts when responses indicate potential issues, such as missed medication doses or frequent headaches. These alerts prompt the clinical team to reach out, usually through the patient portal, and ask follow-up questions or adjust medications right away, if needed. The process can improve patient care by allowing continuous monitoring from home and timely adjustments to treatment plans.
“We wanted to keep a closer eye on our patients with chronic migraine, especially those who need more intensive treatment and need to be followed more closely. This process helps us make sure their treatment plan is going well,” Dr. Rastogi said. “If we’ve had contact with the family and there needs to be a change in treatment, we can prescribe medications or adjust the dosing.
“It lets us address these issues in real time instead of waiting months until the next appointment or relying on the family to contact us in between visits. If we see a pattern that they’re consistently missing a lot of school over several weeks, we definitely want to address it sooner rather than later.”
A wide range of patient benefits
The biggest benefits to kids and their parents include:
- Reporting symptoms every week for close monitoring
- Communicating through the patient portal for a fast response if the child isn’t doing well
- Getting real-time adjustments to medications
- Not needing to visit the doctor in person – and not needing to go to the emergency room for a severe headache if the doctor offer a different treatment plan
- Being reminded of the importance of taking daily medications and not missing school
The weekly survey serves as a digital headache diary, rather than patients keeping up with a diary on their own and reporting details during the next in-person visit.
Physicians benefit, as well, by gaining satisfaction from providing better patient care, more frequent monitoring and a quicker response to issues.
“As a physician, when I start a new patient on a treatment, my goal is for them to feel better,” shared Dr. Rastogi. “It’s hard not knowing what’s going on with a child between visits. This process provides that update sooner. It’s nice to know what’s happening, since we always worry about the kids who are not doing as well. We want to make sure that they are starting to feel better and not missing school, family events and other fun activities.”
Chronic migraine diagnosis and headache treatment
During a migraine, overactivity in certain pathways in the brain leads to increased activity along the nerves going to the head. Some medications to prevent headaches work to balance out the neurotransmitters in the brain. But different medications work in different ways. Some of the newer migraine treatment medications reduce inflammation that happens at the nerve endings.
According to Dr. Rastogi, preventive medications – usually in the form of a daily pill – try to calm down that overactivity on a long-term basis. “We want to help them feel better quickly, and the goal is for medication to be effective but also not cause side effects.
“Headaches are common in kids, but when they have frequent headaches it should be addressed quickly if possible. We want to start them on migraine treatment early and get them feeling better quickly so we can eventually wean them off their medication. The first thing we do when kids come in is to look at their symptoms, get an accurate diagnosis and make sure there isn’t any other serious medical condition causing the headaches.”
Next steps for home monitoring
“Overall, we’re pleased with the good response and participation in home monitoring,” Dr. Rastogi said. “Now that it’s been in place for about a year, we continue to optimize based on patient and family feedback. We plan to survey families to get specific feedback and decide if we need to modify our process in any way.”
The ultimate goal is to increase the number of children participating in home monitoring to watch them more closely.
Lifestyle tips for preventing headaches
If your child has frequent headaches, the first step is to talk to your child’s pediatrician. They may start by focusing on lifestyle management, since there are a lot of lifestyle habits – along with environmental, stress and family issues – that can affect or trigger headaches.
To help prevent headaches:
- Drink plenty of water throughout the day
- Get proper nutrition
- Eat meals on time and throughout the day
- Get enough sleep (teenagers are at particular risk)
- Exercise and get physical activity
- Limit the use of electronics
- Find ways to manage stress
If these factors aren’t a concern for your child, or if their headaches continue on a regular basis, ask the pediatrician to make a referral for an evaluation in the Pediatric Headache Clinic at Phoenix Children’s.