Migraines and ADHD: The Overlooked Connection to Headaches
Migraines and ADHD are comorbid — but few clinicians consider the headache connection when evaluating and treating patients. Studies continue to probe the underlying links between the conditions, but findings show that the impairing symptoms of migraines may aggravate ADHD symptoms and that patient outcomes improve when clinicians avoid compartmentalizing the conditions.
Though few connect the two, attention deficit hyperactivity disorder (ADHD) and headaches can be linked in important ways. Research shows that people with ADHD are at greater risk for experiencing headaches (including migraines, a type of primary headache) compared to people without ADHD.1 2 3 What’s more, headaches are common in other psychiatric conditions, many of which co-occur with ADHD.4
Though the underlying connections between ADHD and headaches are not fully understood, headaches cause undue pain and stress in patients as they attempt to manage existing ADHD symptoms and challenges. Still, the medical community largely overlooks or dismisses the association, to the disservice of patients.
When healthcare providers recognize that these conditions are connected – and approach treatment holistically — quality of care improves and patients function better.
The ADHD-Headache-Migraine Connection
How ADHD Can Cause Headaches
Children with ADHD may be twice as likely to experience headaches as are children without ADHD.1 Children with ADHD are also at greater risk for migraines than are children without ADHD, and frequency of migraine headaches may be directly linked to risk of ADHD.2 The issue extends into adulthood as well. One study estimates that migraines occur with ADHD about 35% of the time in adult patients.3
Headaches, including migraine headaches, do seem to be triggered by ADHD. For one, researchers theorize that headaches may be biologically linked to ADHD,1 and that their co-occurrence stems in part from shared pathophysiological mechanisms potentially related to dopaminergic dysfunction.3
[Get This Free Download: Secrets of the ADHD Brain]
ADHD alone, especially untreated, affects quality of life,5 which may make for stressful environments and scenarios that trigger headaches. The following are some examples of how symptoms, challenges, and other features of ADHD may lead to headaches:
- Time-management and self-regulation difficulties may lead to problems adhering to sleep-wake schedules. An irregular sleep schedule is a major factor behind headaches.6
- Disorganization can cause irregular habits (poor eating, hydration, etc.), which may trigger headaches and migraines.6
- ADHD is linked to increased risk for concussions and head injuries, which may lead to headaches as well.7 Post-concussion headaches are linked to lingering cognitive and concentration problems.8
- Headaches are a common side effect of ADHD medications.9 Loss of appetite and trouble sleeping – common causes behind headaches – are also commonly reported side effects of medication.5
[Read: When It’s Not Just ADHD — Symptoms of Comorbid Conditions]
- ADHD frequently co-occurs with anxiety and mood disorders, which are also linked to headaches and migraines.10 What’s more, headaches tend to be severe and longer-lasting when they co-exist with anxiety.11
- Sleep problems and disorders are highly prevalent in ADHD, and they are also linked to headaches and migraines.12
Migraines and Headaches Can Aggravate ADHD Symptoms
Headaches create additional, stressful obstacles for patients with ADHD — and often worsen existing symptoms and challenges.
- Migraine headaches may cause individuals to miss school or work, compounding issues brought on by time-management difficulties.
- Drowsiness is a common side effect of headache and migraine medications13, which may undermine executive functioning.
- Migraines increase risk for anxiety and mood disorders.14 15
- Migraines are linked to poor sleep quality.12
ADHD and Headaches: Treatment Challenges and Guidelines
Though more research is warranted and needed, evidence clearly links ADHD and its comorbidities to headaches, including migraine headaches. Still, medical providers often have not been trained to consider the connection when treating patients. The result is incomplete, inadequate patient care.
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, or other complicating factors.
The bottom line: The best care for a patient will come when a clinician is able to carefully consider and address all the comorbidities between ADHD and headaches/migraines.
Headache and Migraine Relief with ADHD: Recommended Approaches and Treatments
- Start with the predating condition. If a patient with a long (but possibly not recognized) history of ADHD presents with headaches, consider treating the ADHD first. If the ADHD has not been adequately addressed, it’s possible that new life circumstances could be aggravating stress from it and therefore triggering headaches. If there is a long history of headaches and/or migraines, and a sudden onset or aggravation of ADHD symptoms, consider that the former could be worsening the latter. In an ADHD patient, ask about a family history of headaches/migraines. In a headache/migraine patient, ask about ADHD. This may give you a clue what the patient is biologically at risk for.
- Determine what precedes the headaches. Ask patients about triggers and patterns around headaches, including frequency, duration, and to what degree they interfere with regular functioning. Inconsistent routines and lifestyle habits, for example, may trigger headaches/migraines.16 Hormonal changes during the menstrual cycle are also linked to headaches.17 Ask others who live with the patient for their sense of the issue. (The patient may not always paint an objective picture.) Some triggers for the headaches, such as lack of sleep or anxiety or depression, could also potentially affect ADHD.
- Consider the effects of medication. Treating ADHD and thereby lessening its complications that lead to headaches could be an effective way to reduce headaches in some people. However, medications can also cause side effects (such as sleepiness from some headache medications, or lack of appetite from some ADHD medications) which can worsen the other condition. Consider what medications the patient has already tried and watch for side effects. Switching formulation and delivery, for instance, could reduce headaches.
- Screen for other conditions that could be causing headaches or triggering migraines, like mood and sleep disorders.
- Encourage healthy lifestyle habits. Inform patients about the importance of proper sleep, nutrition (including hydration), and exercise in reducing headaches/migraines and in improving overall functioning.16 Take an individualized approach; certain foods, for instance may trigger migraines,18 and some patients may be better suited to low-impact exercises.19 Asking the patient to keep a diary of their headaches could help understand what triggers them.
- Encourage patients to adopt stress-management and distress-tolerance techniques and other cognitive behavioral approaches. Stress is one of the most common triggers of many types of headaches.20 Learning to manage stress – via mindfulness, progressive muscle relaxation, and other strategies – may alleviate pain and help patients cope in anticipation of and during headaches.21 22
Migraines and ADHD: Next Steps
- Free Download: 9 Conditions Often Linked to ADHD
- Read: The 5 Most Common ADHD Medication Side Effects — and Their Fixes
- Read: What Is Complex ADHD?
The content for this article was derived, in part, from the ADDitude ADHD Experts webinar titled, “The Unexpected Link Between Migraine Headaches and ADHD“ [Video Replay & Podcast #402],” with Sarah Cheyette, M.D., which was broadcast on May 24, 2022.
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1 Pan, P. Y., Jonsson, U., Şahpazoğlu Çakmak, S. S., Häge, A., Hohmann, S., Nobel Norrman, H., Buitelaar, J. K., Banaschewski, T., Cortese, S., Coghill, D., & Bölte, S. (2021). Headache in ADHD as comorbidity and a side effect of medications: a systematic review and meta-analysis. Psychological Medicine, 52(1), 1–12. Advance online publication. https://doi.org/10.1017/S0033291721004141
2 Arruda, M. A., Arruda, R., Guidetti, V., & Bigal, M. E. (2020). ADHD Is Comorbid to Migraine in Childhood: A Population-Based Study. Journal of Attention Disorders, 24(7), 990–1001. https://doi.org/10.1177/1087054717710767
3 Hansen, T. F., Hoeffding, L. K., Kogelman, L., Haspang, T. M., Ullum, H., Sørensen, E., Erikstrup, C., Pedersen, O. B., Nielsen, K. R., Hjalgrim, H., Paarup, H. M., Werge, T., & Burgdorf, K. (2018). Comorbidity of migraine with ADHD in adults. BMC neurology, 18(1), 147. https://doi.org/10.1186/s12883-018-1149-6
4 Minen, M. T., Begasse De Dhaem, O., Kroon Van Diest, A., Powers, S., Schwedt, T. J., Lipton, R., & Silbersweig, D. (2016). Migraine and its psychiatric comorbidities. Journal of neurology, neurosurgery, and psychiatry, 87(7), 741–749. https://doi.org/10.1136/jnnp-2015-312233
5 Agarwal, R., Goldenberg, M., Perry, R., & IsHak, W. W. (2012). The quality of life of adults with attention deficit hyperactivity disorder: a systematic review. Innovations in clinical neuroscience, 9(5-6), 10–21.
6Robblee, J., & Starling, A. J. (2019). SEEDS for success: Lifestyle management in migraine. Cleveland Clinic journal of medicine, 86(11), 741–749. https://doi.org/10.3949/ccjm.86a.19009
7Cook, N. E., Teel, E., Iverson, G. L., Friedman, D., Grilli, L., & Gagnon, I. (2022). Lifetime History of Concussion Among Youth With ADHD Presenting to a Specialty Concussion Clinic. Frontiers in neurology, 12, 780278. https://doi.org/10.3389/fneur.2021.780278
8Renga V. (2021). Clinical Evaluation and Treatment of Patients with Postconcussion Syndrome. Neurology research international, 2021, 5567695. https://doi.org/10.1155/2021/5567695
9Kolar, D., Keller, A., Golfinopoulos, M., Cumyn, L., Syer, C., & Hechtman, L. (2008). Treatment of adults with attention-deficit/hyperactivity disorder. Neuropsychiatric Disease and Treatment, 4(2), 389–403. https://doi.org/10.2147/ndt.s6985
10Katzman, M. A., Bilkey, T. S., Chokka, P. R., Fallu, A., & Klassen, L. J. (2017). Adult ADHD and comorbid disorders: clinical implications of a dimensional approach. BMC psychiatry, 17(1), 302. https://doi.org/10.1186/s12888-017-1463-3
11Mercante, J. P., Peres, M. F., & Bernik, M. A. (2011). Primary headaches in patients with generalized anxiety disorder. The journal of headache and pain, 12(3), 331–338. https://doi.org/10.1007/s10194-010-0290-4
12Rains, J. C., & Poceta, J. S. (2012). Sleep-related headaches. Neurologic Clinics, 30(4), 1285–1298. https://doi.org/10.1016/j.ncl.2012.08.014
13Lew C, Punnapuzha S. Migraine Medications. [Updated 2022 May 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK553159/
14Breslau, N., Lipton, R. B., Stewart, W. F., Schultz, L. R., & Welch, K. M. (2003). Comorbidity of migraine and depression: investigating potential etiology and prognosis. Neurology, 60(8), 1308–1312. https://doi.org/10.1212/01.wnl.0000058907.41080.54
15Peres, M., Mercante, J., Tobo, P. R., Kamei, H., & Bigal, M. E. (2017). Anxiety and depression symptoms and migraine: a symptom-based approach research. The Journal of Headache and Pain, 18(1), 37. https://doi.org/10.1186/s10194-017-0742-1
16Woldeamanuel, Y. W., & Cowan, R. P. (2016). The impact of regular lifestyle behavior in migraine: a prevalence case-referent study. Journal of neurology, 263(4), 669–676. https://doi.org/10.1007/s00415-016-8031-5
17Ornello, R., Frattale, I., Caponnetto, V., De Matteis, E., Pistoia, F., & Sacco, S. (2021). Menstrual Headache in Women with Chronic Migraine Treated with Erenumab: An Observational Case Series. Brain sciences, 11(3), 370. https://doi.org/10.3390/brainsci11030370
18 Hindiyeh, N. A., Zhang, N., Farrar, M., Banerjee, P., Lombard, L., & Aurora, S. K. (2020). The Role of Diet and Nutrition in Migraine Triggers and Treatment: A Systematic Literature Review. Headache, 60(7), 1300–1316. https://doi.org/10.1111/head.13836
19Barber, M., & Pace, A. (2020). Exercise and migraine prevention: a review of the literature. Current Pain and Headache Reports, 24(8), 39. https://doi.org/10.1007/s11916-020-00868-6
20Pellegrino, A., Davis-Martin, R. E., Houle, T. T., Turner, D. P., & Smitherman, T. A. (2018). Perceived triggers of primary headache disorders: A meta-analysis. Cephalalgia : An International Journal of Headache, 38(6), 1188–1198. https://doi.org/10.1177/0333102417727535
21Simshäuser, K., Lüking, M., Kaube, H., Schultz, C., & Schmidt, S. (2020). Is Mindfulness-Based Stress Reduction a Promising and Feasible Intervention for Patients Suffering from Migraine? A Randomized Controlled Pilot Trial. Complementary Medicine Research, 27(1), 19–30. https://doi.org/10.1159/000501425
22Wachholtz, A., Vohra, R., & Metzger, A. (2019). A reanalysis of a randomized trial on meditation for migraine headaches: Distraction is not enough but meditation takes time. Complementary Therapies in Medicine, 46, 136–143. https://doi.org/10.1016/j.ctim.2019.08.011