Headache Individualized Healthcare Plan SECTION III: Brief description of medical condition: Headaches A headache may appear as a sharp pain, a throbbing – sensation or a dull ache in the head. Migraine a condition marked by moderate to severe headache that usually lasts from 4 hours to 3 days – that typically affects one side of the head. A migraine can be accompanied by nausea, vomiting, disturbed vision, and sensitivity to light and sound. Avoid circumstances that may lead to potential emergency: SCHOOL DAY: PHYSICAL EDUCATION: Avoid triggers. Restrictions for Physical Education Monitor for symptoms No □ Notify School Nurse Yes □ Otherwise, call parent If yes, please specify: Symptoms: Severe pain □ Aura/ Numbness/ Tingling/Visual Disturbances □ Nausea with or without vomiting □ Other___________________________________ □ Triggers: Missing a meal or particular foods □ Weather Changes □ Exertion □ Lack of sleep □ Stress □ Odors □ Loud/continuous noises □ FIELD TRIPS: BUS TRANSPORTATION: Requires assistance: Special arrangements Unlicensed Medication Assistant No □ □ Nurse, if indicated Yes □ □ None If yes, please specify: □ Parent/Guardian attending □ If yes, please specify: EMERGENCY DRILLS / SCHOOL CRISIS OTHER: During Crisis Event Follow School Safety Plan. After School Care: □ In event of building evacuation, School Nurse or Extracurricular Activity: □ Medication Assistant will evacuate with medications. In event of building evacuation, School Nurse □ Location is: Student requires assistance to evacuate building? □ No Yes, describe ______________________ □ □
Headache Individualized Healthcare Plan SECTION III: Brief description of medical condition: Headaches – A headache may appear as a sharp pain, a throbbing sensation or a dull ache in the head. Migraine – a condition marked by moderate to severe headache that usually lasts from 4 hours to 3 days that typically affects one side of the head. A migraine can be accompanied by nausea, vomiting, disturbed vision, and sensitivity to light and sound. Avoid circumstances that may lead to potential emergency: SCHOOL DAY: PHYSICAL EDUCATION: Avoid triggers. Monitor for symptoms Notify School Nurse Otherwise, call parent Restrictions for Physical Education □ No □ Yes If yes, please specify: Symptoms: □ Severe pain □ Aura/ Numbness/ Tingling/Visual Disturbances □ Nausea with or without vomiting □ Other___________________________________ Triggers: □ Missing a meal or particular foods □ Weather Changes □ Exertion □ Lack of sleep □ Stress □ Odors □ Loud/continuous noises FIELD TRIPS: BUS TRANSPORTATION: Requires assistance: □ Unlicensed Medication Assistant □ Nurse, if indicated □ None □ Parent/Guardian attending If yes, please specify: Special arrangements □ No □ Yes If yes, please specify: EMERGENCY DRILLS / SCHOOL CRISIS OTHER: □ During Crisis Event Follow School Safety Plan. □ In event of building evacuation, School Nurse or Medication Assistant will evacuate with medications. □ In event of building evacuation, School Nurse Location is: □ Student requires assistance to evacuate building? □ No □ Yes, describe ______________________ After School Care: Extracurricular Activity:
Headache%20IHCP%202017%20(Final).docx