Previous research has highlighted associations between migraine and certain psychiatric disorders, including depression and bipolar disorder. Now, following indications of an association between migraine and attention deficit and hyperactivity disorder (ADHD) in children and adolescents, a new study has demonstrated a significant comorbidity of the 2 conditions in adults.
The study of 26,456 patients also found that women—who account for more than 75%
of the 38 million people in the United States who experience migraine—and older age increased comorbidity.
Between November 2015 and September 2017, patients who participated in the Danish Blood Donor Study were assessed for migraine and ADHD using a 2-question migraine and an 18-question ADHD module. The migraine questionnaire asked if participants had ever had migraine and if they ever had visual disturbances (aura) lasting 5-60 minutes followed by headache. The ADHD questionnaire had patients rate statements on a scale of 1-5.
While 24.2% of participants screened positive for migraine, 2.61% screened positive for ADHD, and 0.9% reported having both. The researchers observed a strong link between migraine and ADHD (OR, 1.81; 95% CI, 1.53-2.12). While migraine was associated with both ADHD endophenotypes—inattention and hyperactivity-impulsivity—migraine with aura was significantly more likely to be associated with ADHD.
The comorbidity of the 2 conditions was most prevalent among those aged 52-53 and in their 40s compared to those aged 17-29. This was inversely correlated with the age distribution of ADHD symptoms, potentially indicating that the comorbidity occurs later in life when compared to ADHD alone, or that ADHD symptoms mask the presence of migraine in younger patients.
“The origin of comorbidity is not obvious and typical prognostic features such as age of onset, and the female-to-male ratio of the 2 diseases are somewhat contradiction,” noted the authors. While migraine is twice as prevalent in females and onset is typically between adolescence and the late 50s, ADHD has an early onset with a pooled worldwide prevalence of 5.3% in children and adolescents.
“It has previously been suggested that the co-occurrence of migraine and ADHD originates from common pathophysiological mechanisms potentially related to dysfunctions in the dopaminergic system,” the authors added. “This arises because many of the migraine symptoms, including prodromal symptoms, can be provoked with dopamine receptor stimulation, and some can even be quantified in rat models with dopaminergic activation.”
Dopamine has long been thought to be involved in ADHD pathology. However, the comorbidity could also be more complex because of common comorbidities of other psychiatric disorders, including anxiety and mood disorders, the researchers cautioned.
Hansen T, Hoeffding L, Kogelman L, et al. Comorbidity of migraine with ADHD in adults [published online October 16, 2018]. BMC Neurology.