Study Finds Higher Prevalence of ADHD in Adult Migraine Patients
New research reveals a bidirectional relationship in adult patients with migraine and ADHD symptoms, specifically impulsivity.
October 10, 2023
Adults who suffer from migraines have a higher prevalence of ADHD symptoms, a new study published in the Journal of Attention Disorders found.1 While studies have previously demonstrated the higher incidence of migraines in ADHD patients,2 this study is the first to show that the association works the other way, establishing a bidirectional relationship between the two conditions. In addition, most previous studies were conducted in children or adolescents and were based on patients with ADHD who were assessed for migraines. This study focused on adults suffering from migraines whose ADHD symptoms may be undiagnosed. The finding could have implications for the assessment of migraine patients and could help to uncover undiagnosed ADHD in this group.
The observational cohort study involved 250 adult participants: 150 controls, who did not have migraines, and 100 patients who were treated in a headache clinic for episodic migraines. To assess hyperactivity, impulsivity, and attention deficit, researchers used the ADHD Rating Scale (ADHD-RS), the Adult ADHD Self-Report Scale (ASRS), and Plutchik’s Impulsivity Scale.
The researchers identified a much higher incidence of ADHD symptoms, specifically impulsivity, in the group of migraine patients compared to the control group. They found no difference in ADHD and ASRS scores between patients with or without aura.
The average ratings, according to ASRS:
- Inattention: 5 in migraine cases vs 2.7 in controls
- Hyperactivity: 4 in migraine cases vs 2.5 in controls
- Impulsivity: 2 in migraine cases vs 1.1 in controls
Migraine Headaches and ADHD: Understanding the Connection
This study brings the scientific community one step closer to fully understanding the link between migraines and ADHD, which is critical to ensuring the best care for patients.
“Medical providers often have not been trained to consider the connection when treating patients. The result is incomplete, inadequate patient care,” explains pediatric neurologist Sarah Cheyette, M.D., in the ADDitude webinar “The Unexpected Link Between Migraine and ADHD.” “A patient with undiagnosed ADHD and debilitating headaches, for example, likely will be referred to a neurologist – many of whom do not specialize in ADHD and may not consider its connection to headaches. Similarly, a provider treating ADHD may not be comfortable treating headaches, or even identifying co-occurring conditions.”
The new study helps fill in the gaps to build an in-depth understanding of the mechanisms underlying both ADHD and migraines, which researchers believe may have much in common.
“The pathophysiology of migraine is complex and not fully understood, although different structures and neurotransmitters involved in the genesis of migraine, such as serotonin and glutamate, have been described,”3 wrote the study’s authors. “These disorders may share pathophysiological mechanisms that explain their association.”
Not only do ADHD and migraines potentially share underlying neurological mechanisms, but each condition may also work to exacerbate the other. According to Cheyette, migraine can create additional, stressful obstacles for patients with ADHD, including missed work, increased drowsiness, poor sleep quality, and heightened anxiety, which often worsens ADHD symptoms and challenges. Conversely, symptoms of ADHD can lead to behaviors that worsen migraines; for example, disorganization can cause irregular habits (poor eating, hydration, sleep patterns), and impulsivity can increase the incidence of concussions, all of which exacerbate migraines.
“When healthcare providers recognize that these conditions are connected — and approach treatment holistically — the quality of care improves,” Cheyette says, “and patients function better.”
1 Gonzalez-Hernandez, A., Cano-Yepes, A., Sainz de Aja-Curbelo, V., Santana-Farré, R., Rodríguez-Sosa, T., & Cabrera-Naranjo, F. (2023). Attention Deficit Hyperactivity Disorder in Adults With Migraine. Journal of Attention Disorders, 0(0). https://doi.org/10.1177/10870547231199256
2 Hansen, T.F., Hoeffding, L.K., Kogelman, L. et al. Comorbidity of migraine with ADHD in adults. BMC Neurol 18, 147 (2018). https://doi.org/10.1186/s12883-018-1149-6
3 Dodick, D.W. (2018). A Phase-by-Phase Review of Migraine Pathophysiology. Headache: The Journal of Head and Face Pain, 4-16. https://doi.org/10.1111/head.13300