ADHD News & Research

Study: Migraines in Children Increases Risk of Anxiety, Depression

Children with migraines face a higher risk for symptoms of anxiety and depression than do their peers without migraines, according to a new systematic review and meta-analysis.

February 24, 2023

Children with migraines are more likely to experience symptoms of anxiety and depression than are children without migraines, according to a recent systematic review and meta-analysis of 80 studies recently published in JAMA Pediatrics. 1

Researchers found an association between migraine and both anxiety and depressive symptoms, and they concluded that children aged 18 and younger with migraines are significantly more likely to develop anxiety and depressive disorders than are children without migraines. However, they wrote, “it is unclear whether having anxiety and depressive symptoms or disorders affects migraine outcomes or incidence.”

WebMD defines migraine as a “neurologic disorder that often causes a strong headache. The headache comes in episodes and sometimes comes with nausea, vomiting, and sensitivity to light.” According to the website, one in five children and teens are prone to having headaches, and roughly 5% struggle with migraine headaches — some as early as four years old.

The Migraine-ADHD Connection

While researchers did not collect information regarding other co-existing conditions, such as ADHD, a 2020 population-based study published in the Journal of Attention Disorders found that children with ADHD are at greater risk for migraines than children without ADHD. Further, the risk of ADHD may directly link to the frequency of migraine headaches. 2

“Headaches, including migraine headaches, do seem to be triggered by ADHD,” said Sarah Cheyette, M.D., a pediatric neurologist at the Palo Alto Medical Foundation in Northern California. “For one, researchers theorize that headaches may be biologically linked to ADHD and that their co-occurrence stems, in part, from shared pathophysiological mechanisms potentially related to dopaminergic dysfunction.” 3,4 Cheyette discussed the link between migraine headaches and ADHD in a recent ADDitude webinar.

“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,” she said.

When asked if their children with ADHD experience migraines, 16% of ADDitude’s reader panel members responded in the affirmative. Migraine was found in 26% of ADHD patients between the ages of 6 and 18 and 10% of healthy controls, according to a 2018 study published in Brain and Development.5

One reader panel member from Indiana said: “My child sometimes gets auras but always gets nausea and dizziness. It’s terrible to see her in pain.”

“This has been horrible,” wrote a parent from California. “A pediatrician first suggested he had migraines when he was five. In third grade, he missed 35 days of school. Now in 4th grade, he does a reduced school schedule because of his migraines. He now has POTS [Postural orthostatic tachycardia syndrome], too. Seeing him in pain is horrible, and we don’t have an effective treatment plan yet.”

“She has missed so much school due to migraines,” said another parent. “She has headaches, nausea, fatigue, irritability, sensitivity to light and sound, and sometimes vomiting. Her migraines started around age 11 or 12.”

Treatment for ADHD and Migraine in Tandem

While migraines and ADHD are comorbid, few clinicians consider the headache connection when evaluating and treating patients. “The medical community largely overlooks or dismisses the association, to the disservice of patients,” Cheyette said. “When healthcare providers recognize that these conditions are connected — and approach treatment holistically — the quality of care improves, and patients function better.”

“Our 15-year-old son began getting migraines about a year into puberty,” said a parent from South Carolina. “He has nausea, stomach pain, and irritability. His pediatric neurologist started him on magnesium and vitamin B2, which have helped tremendously.”

“We noticed them [migraines] very early on (at age 6 or 7) as stomachaches, which the doctor finally deduced were ‘abdominal migraines.’ It all just fit,” said a parent from Pennsylvania. “Today, at age 14, the primary symptoms are still nausea as much as headache and brief, impaired vision when they move.”

The researchers behind the new meta-analysis recommend that clinicians routinely screen children and adolescents with migraines for anxiety and depression. In a 2022 survey of 1,187 caregivers, ADDitude found high comorbidity rates between ADHD and both anxiety (67% of teens with ADHD) and depression (46% of teens with ADHD).

“These results have critical implications for clinical practice, underscoring the need to screen all children and adolescents with migraine for anxiety and depression,” researchers wrote. “Future work should address these questions and aim to determine whether trauma- and stressor-related symptoms and disorders are associated with migraine in children and adolescents.”

Migraines and ADHD: Next Steps

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1Falla, K., Kuziek, J., Mahnaz, S.R., Noel, M., Ronksley, P.E., Orr, S.L. (2022) Anxiety and Depressive Symptoms and Disorders in Children and Adolescents with Migraine: A Systematic Review and Meta-analysis. JAMA Pediatr. 176(12):1176–1187. doi:10.1001/jamapediatrics.2022.3940

2Arruda, 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.

3Pan, 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.

4Hansen, 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.

5Kutuk, M.O., Tufan, A.E., Guler, G., Yalin, O.O., Altintas, E., Bag, H.G., Uluduz, D., Toros, F., Aytan, N., Kutuk, O., Ozge, A. (2018). Migraine and Associated Comorbidities are Three Times More Frequent in Children with ADHD and Their Mothers. Brain Dev. 40(10):857-864.