The Connection Between Migraine and ADHD

Written by: Kylie Petrarca, RN, BSN

Medically Reviewed by: Andrea D. Murphy, MSN, APRN, ANP-BC, NEA-BC

Edited by: Melissa Calise and Leigh Serth

What is ADHD?

Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder that is diagnosed based on a set of behavioral symptoms that fall under either inattentive or hyperactive/impulsive classifications. People can also have a mix of both inattentive and hyperactive/impulsive symptoms. In order to be diagnosed with ADHD, the DSM-5 states symptoms need to be present before age 12, cannot be attributed to a different psychiatric disorder or occur during a psychotic disorder and are not a manifestation of oppositional behavior.¹ View the full ADHD diagnosis and symptom lists here.

The Connection Between Migraine and ADHD

A study by Fasmer, et. al assessed the prevalence of migraine in adults diagnosed with ADHD. They found that 28.3% of the 572 subjects with ADHD had migraine, whereas only 19.2% of the 675 subjects without ADHD in the control group had migraine.²  Another study by Hansen, et. al  assessed the possible comorbidity of migraine with ADHD. They found that migraine was strongly associated with ADHD. People who had migraine with visual disturbances were found to be more often affected by ADHD symptoms.³ In addition, the study reported that the comorbidity was most prevalent among people who were in their 40s, with the prevalence peaking among people who were 52-53 years old.³

It is unknown why ADHD and migraine can occur comorbidly but there are several possible mechanisms:⁴

1. Neurotransmitter imbalances: Imbalances in dopamine, serotonin, GABA and norepinephrine are likely involved in the conditions co-occurring. It is thought that dopamine plays a key role in the relationship between ADHD and migraine.^5,6
2. Genetics: Gene KIAA0564 was found to be associated with migraine disease in people living with bipolar affective disorder as well as ADHD.⁷
3. Abnormalities of the hypothalamic-pituitary-adrenal axis (HPA axis) may play a role. The hypothalamic-pituitary-adrenal axis is responsible for the stress response system and regulates the autonomic nervous system.

Commonalities Between Migraine and ADHD

• Both disorders are comorbid with anxiety, depression, sleep disorders and bipolar disorder.^8,9
• Both are heavily influenced by genetics. “Twin studies indicate that 75%–90% of ADHD is caused by genetic factors. If one person in a family is diagnosed with ADHD there is a 25%–35% probability that another family member also has ADHD, compared to a 4%–6% probability for someone in the general population.”¹⁰ Similarly, if one parent has migraine disease, there is a 50% chance that their child will inherit it. If two parents have migraine, there is a 75% chance that their child will also inherit it.¹¹
• Cognitive dysfunction is a common symptom in both ADHD and migraine patients (ex. people have a hard time staying focused).
• Both conditions are diagnosed based on presenting symptoms, there are no lab tests or biomarkers to diagnose either condition.
• ADHD and migraine can have a profound impact on a person’s schooling and work life.

ADHD and Pediatric Migraine

A national survey found that ADHD is affects about 8% of children and is one of the most common mental health conditions in this age group.^12,13 Similarly, migraine can affect up to 10% of school aged children.¹⁰ Both conditions can impact many aspects of childhood including attending and succeeding in school, making friends, and participating in sports. One study reported that children who had school performance issues and more than eight headache days per month were eight times more likely to have ADHD than those who did not.⁴ They also found that the prevalence of ADHD was significantly higher in children with migraine overall (10.8% vs. 2.6%), episodic migraine (10.2% vs. 2.6%) and chronic migraine (19.4% vs. 2.6%) compared to controls.⁴ Lastly, they identified numerous risk factors for having both ADHD and migraine which include: male sex, prenatal exposure to tobacco and below average school performance.⁴ People who have children living with ADHD and/or migraine should talk to their teachers and school nurse to ensure they have proper accommodations in place. We encourage parents, students and teachers to visit Migraine at School for more information.

Treatments for ADHD

For children under six years old living with ADHD, the American Academy of Pediatrics recommends beginning treatment with behavioral therapy.¹⁴ For people older than six years, medication and behavioral therapy can be tried together.¹⁴ Stimulants are typically used as a first line treatment. They increase levels of two neurotransmitters, norepinephrine and dopamine. Increasing these neurotransmitters can reduce hyperactivity, help a person pay attention and stay motivated. These medications are addictive and the person should be monitored regularly by a clinician. It should be noted that headaches are a common side effect of stimulants. Some examples of stimulants include amphetamine, dextroamphetamine and methylphenidate. Non-habit forming medication options include non-stimulants such as atomoxetine or viloxazine. These medications increase norepinephrine levels in the brain. Lastly, antidepressants may be used since many people with ADHD have other mental health comorbidities such as anxiety and depression. Antidepressants also increase the levels of neurotransmitters in the brain. 

In both children and adults, migraine is also commonly treated with tricyclic antidepressants such as amitriptyline. Behavioral therapy such as cognitive behavioral therapy is also used. For more information about migraine treatments, click here.

What Type of Doctor Should I See for Migraine and ADHD? 

If a person suspects they have ADHD and migraine they should consult their primary care doctor. Parents may notice signs of ADHD and/or migraine in their children and should contact their child’s pediatrician. Either a primary care provider or pediatrician can diagnose and treat both conditions but may refer a person to a neurologist, psychologist or a psychiatrist for additional support. Some healthcare providers have additional training in headache medicine and are often recommended to best treat a person’s migraine disease.

A Note To Patients and Providers

Headaches are a common side effect of stimulants and providers should inform patients to report the onset of a new headache. However, these headaches are different from migraine attacks.

Parents should work closely with school nurses and teachers if they have a child that has migraine and/or ADHD. Migraine at School has great resources for students, parents and teachers to help students succeed in school. You can also become a Migraine at School Ambassador to educate the community and help raise awareness about migraine disease in school. It is important to note that children may present with behavioral symptoms (retreating to a dark room, avoiding activity, etc.) or non-headache complaints (car sickness, nausea, abdominal pain) rather than more typical complaints of head pain or light or sound sensitivity. If a parent or teacher notices that a child is having a hard time paying attention in school or is not succeeding, then there may be an underlying cause such as ADHD and/or migraine.

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Resources 

1. Children and Migraine
2. Migraine Treatments
3. Migraine at School
4. Headaches and Stimulants
5. ADHD Support Groups
6. ADHD Webinar Series

References

1. https://www.aafp.org/dam/AAFP/documents/patient_care/adhd_toolkit/adhd19-assessment-table1.pdf
2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3225610/pdf/406_2011_Article_203.pdf
3. https://bmcneurol.biomedcentral.com/articles/10.1186/s12883-018-1149-6
4. Arruda MA, Arruda R, Guidetti V, Bigal ME. ADHD is comorbid to migraine in childhood: a population-based study. J Atten Disord. 2017:1087054717710767.
5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3225610/pdf/406_2011_Article_203.pdf
6. https://bmcneurol.biomedcentral.com/articles/10.1186/s12883-018-1149-6
7. https://pubmed.ncbi.nlm.nih.gov/20528957/
8. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3225610/pdf/406_2011_Article_203.pdf
9. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2970709/
10. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2626918/
11. https://americanmigrainefoundation.org/resource-library/migraine-facts/
12. https://www.psychiatry.org/patients-families/adhd/what-is-adhd
13. https://publications.aap.org/pediatrics/article/144/4/e20192528/81590/Clinical-Practice-Guideline-for-the-Diagnosis
14. https://publications.aap.org/pediatrics/article/144/4/e20192528/81590/Clinical-Practice-Guideline-for-the-Diagnosis

*The contents of this blog are intended for general informational purposes only and do not constitute professional medical advice, diagnosis, or treatment. Always seek the advice of a physician or other qualified health provider with any questions you may have regarding a medical condition. The writer does not recommend or endorse any specific course of treatment, products, procedures, opinions, or other information that may be mentioned. Reliance on any information provided by this content is solely at your own risk.