Forgetting to eat and drink, hyperfocusing, and neglecting routines… for many people with ADHD, not managing these symptoms can lead to consequences such as the dreaded "ADHD Tax." But, for Sarah Alexander-Georgeson, executive dysfunction also comes with a painful penalty - increased migraine attacks. So, what's the connection between ADHD and migraine? Sarah delves into how one condition can impact the other, offering five personal insights into how she manages both.

Research shows that people with ADHD (attention deficit hyperactivity disorder) are more likely to experience migraine.

For example, in a study published by the National Institutes of Health (NIH), 26% of children and adolescents with ADHD experienced migraines, compared to 9.9% of those without ADHD. Likewise, tension headaches were experienced by 32.4% of those with ADHD in the study, compared to 27.9% of those without.

But what's the link? Why are people with ADHD more susceptible to migraine compared to the general population?

How could ADHD symptoms lead to migraine attacks?

One possible link between conditions is stress.

Executive dysfunction (difficulty managing thoughts, actions, and emotions), difficulty focusing, and sensory issues can lead to stressful situations for those with ADHD.

And there's an incentive for managing these symptoms and avoiding stress, as stress is also a common trigger for migraine attacks. In a study held by the American Headache Society, 4 out 5 people said stress was a migraine trigger for them.

Worse, many people with migraine struggle with a migraine hangover after an attack, meaning they may not feel their best for hours or even days after the headache's subsided. Difficulty reaching equilibrium after an attack can worsen ADHD symptoms or their consequences (procrastination, inability to focus, etc.) and cause more stress, potentially leading to increased migraine frequency.

Another link may be how ADHD and inconsistent daily routines can affect migraine.

Following a routine, managing what and when you eat, and keeping up with hydration are common difficulties for people with ADHD. I know I struggle to keep to a routine! I never eat at the same time of day. Sometimes, hyperfocus can cause me to forget to eat entirely.

Sadly, neglecting basic needs can become migraine triggers if not managed.

5 ways ADHD affects my migraine (and how I try to combat them)

These are some ways my ADHD affects my migraine and how I manage them:

1. I forget to stay hydrated

When you're utterly absorbed by whatever you're doing, or, on the opposite end of the scale, experiencing task paralysis that makes completing anything feel difficult, drinking water isn't at the forefront of our minds.

But if I don't stay hydrated, I soon pay the price. My head becomes fuzzy, my thoughts become cloudy, and I get intense pain in my head.

I don't always notice the onset of these symptoms until it's too late. By then, I'm too focused on the pain to ascribe it to a lack of hydration. ADHD often makes me forget the correlation between lack of fluids and migraine until I look back in hindsight.

I manage situations like these by drinking plenty of fluids, usually cold water. That won't stop the headache immediately, but I still need to hydrate, even if I’m too late to avoid the headache. Then, if I can, I lie down in a dark room and wear a cold compress on my head.

To prevent these situations, I'm turning the tracking of my daily liquid intake into a habit. I drink much less when I'm busy, distracted, or out having fun with friends, so I keep a flask of juice beside me or with me when I go out.

Experience has shown me that I won't think to stop and buy a drink during an outing. If I'm busy, having a bottle beside me is easier than pulling myself away from anything to pour a drink in the kitchen.

2. Eating gets forgotten when I socialize

When I don't eat, the resulting tension headaches can be unbearable. Yes, I feel the hunger pains and mounting pain in my head, but the 100% focus I have on my friends means I often put my needs to the side until it's too late.

Situations like this can happen a lot - especially when many of your friends also have ADHD.

I manage this by setting an alarm on my phone for dinnertime and finding somewhere to eat. I also have cereal bars in my backpack to snack on. If I am going to be out all day, I ask my mum to call me to ensure I haven’t skipped any meals.

3. Overthinking keeps me awake all night

Living with chronic migraine requires a healthy amount of sleep for prevention and recovery.

I know, I don't know what a "healthy amount" is either. But, as someone with ADHD, I often lie in bed at night with a mind that’s racing with billions of thoughts that I can't switch off. I'm kept awake until the early hours, thus resulting in poor sleep hygiene and migraines galore.

I manage this with a sleep routine and sleep-aid gadgets. I read every night until I'm tired enough for my book to fall on my face. I use a sensory-calming light that casts waves of all different colors all over my bedroom and chills me out. I listen to an app that plays rain noises.

I've tried to model my bedroom into a peaceful sanctuary, which usually works.

Note: Experts recommend that adults sleep between 7 and 9 hours a night, though age and different needs can widen those parameters.

4. Hyperfocusing too much

Hyperfocus encompasses all the above and is often the reason for a lack of eating, drinking, and restful sleep.

As the name suggests, hyperfocus isn't a lack of focus but too much of it, usually for extended periods. Many ADHDers can't choose where their all-consuming concentration goes, so hyperfocus can be a curse rather than a superpower. Think of having a looming deadline for work but spending hours on a pet project instead.

Extended, unbreakable concentration means I will push myself through the pain of the migraine to continue my work. I've stayed up well into the night to complete a TV series, a piece of sewing, or a drawing, always to my detriment. The resulting migraine can last for days.

To combat this, I plan adequate breaks before picking up a project. Unfortunately, ignoring a pre-planned schedule is easy when you're lost in the moment. Breaking my hyperfocus is something I struggle with a lot, and I'm still learning how to manage it.

If I become aware that I'm "falling down the rabbit hole," I try to find ways to climb out. Picking up the phone to call a friend can be distracting enough to disrupt hyperfocus. The internal demand to keep going has waned or passed by the time our conversation's finished.

5. Stress

As I said in the introduction, migraine is often exacerbated by stress, and ADHD is a stressful condition.

Although not an official symptom for diagnosis, a lot of ADHDers agree that struggles with emotions and perceived rejection are some of the most impairing aspects of ADHD.

In my case, I constantly question whether people like me. I stress that I've said the wrong thing long after I said it. I worry that I'm too sensitive, that I'm talking too much and oversharing, that I don't pay enough attention, or that I accidentally interrupted someone. The list goes on.

Getting a handle on this isn't easy, but it helps to talk with other neurodiverse people and get their opinions on things that have been worrying me. I practice self-love and try not to be too hard on myself. Most importantly, I make sure I'm around people who know and support me.

The takeaway

As a general tip, I find that journaling also helps. I keep a journal and a headache diary, which allow me to crossmatch my migraine symptoms with any potential triggers I've noted down during the day. These notes are on my phone for easy accessibility.

Living with ADHD and migraine has its challenges, but there are certainly ways of coping, and I hope you find yours.

The information presented is solely for educational purposes, not as specific advice for the evaluation, management, or treatment of any condition.

The individual(s) who have written and created the content and whose images appear in this article have been paid by Teva Pharmaceuticals for their contributions. This content represents the opinions of the contributor and does not necessarily reflect those of Teva Pharmaceuticals. Similarly, Teva Pharmaceuticals does not review, control, influence, or endorse any content related to the contributor's websites or social media networks. This content is intended for informational and educational purposes and should not be considered medical advice or recommendations. Consult a qualified medical professional for diagnosis and before beginning or changing any treatment regimen.

NPS-ALL-NP-01343 AUGUST 2024