Comorbidity of migraine with ADHD in adults

DOI: https://doi.org/10.1186/s12883- 018- 1149- 6

Abstract-Summary Migraine and Attention Deficit and Hyperactivity Disorder (ADHD) have been found to be associated in child and adolescent cohorts; however, the association has not been assessed in adults or otherwise healthy population.

Assessing the comorbidity between ADHD and migraine may clarify the etiopa-

thology of both diseases.

The objective is to assess whether migraine (with and without visual distur-

bances) and ADHD are comorbid disorders.

Logistic regression was used to examine the comorbidity between migraine and

ADHD, and their associated endophenotypes.

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2 Mechanisms

Post-hoc analysis showed that migraine with visual disturbance was generally associated with a marginally higher risk of ADHD and this was independent of ADHD endophenotypes.

Migraine and ADHD were demonstrated to be comorbid disorders; the associa- tion with ADHD was most prominent for participants with migraine with visual disturbances.

Extended: Logistic regression was used to analyze the association between migraine and ADHD (dichotomous variables) in the study population, adjusting for age, sex, and the interaction between sex and age, with migraine as the dependent variable.

These results contribute to the understanding of genetic correlation seen between ADHD and migraine and seeds future studies that will elucidate which genetic and environmental factors contribute to migraine-ADHD comorbidity.

Background To migraine, ADHD has an early onset and a pooled worldwide prevalence of 5.3% in child and adolescent populations [410].

The comorbidity between migraine and ADHD has also been assessed [411–414]. In adults, a clinical case-control study of ADHD (n = 572/675) found an increased prevalence of migraine when compared to community controls [412], and subse- quently the same investigators showed a positive association between prescription of anti-migraine and anti-ADHD drugs to adults in the total Norwegian population(n

4mill) [413].

In line with this, Arruda and others reported a higher prevalence of ADHD among children with migraine (5–12 years) than for non-headache individuals in a pediat- ric population cohort (n = 5671) [415].

According to the recently published meta-analysis including child and adoles- cence studies and the Fasmer and others adult study, there is a positive association between migraine and ADHD with odds-ratio of 1.3 [412, 416].

Using a cross-sectional study of adults (age 18–65 years), we test the hypothesis that migraine is comorbid with ADHD in 26,456 participants using clinically vali- dated questionnaires.

Methods At enrolment, each individual gives oral and written informed consent to participate in DBDS and subsequently answers a digital tablet-based questionnaire including a migraine (two questions) and an ADHD (18 questions) module.

The excluded individuals did not differ significantly with respect to age (chi-

square test, p-value = 0.24) compared to the study population.

The excluded individuals were slightly older (median age: 44 years, IQR = 31–54 years) when compared to the study population (median age: 42 years, IQR = 30–52 years) (Wilcoxon test, P-value = 3.7e-8).

The frequency of migraine in individuals excluded because of missing informa- tion in the ASRS questionnaire was similar to that of the study population (24.1%). Further, the frequency of ADHD in individuals excluded because of missing

items in the SQM questionnaire was similar to that of the study population 4.2%.

2.3 Comorbidities

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Results The highest risk was found for migraine with visual disturbances and ADHD symp- toms (OR = 2.05, 95CI%: 1.55–2.68, P = 3.3e-11).

Discussion We address the comorbidity of migraine and ADHD symptoms in a healthy popula- tion of 29,489 adults using two clinically validated questionnaires (SQM and ASRS). Stratified analyses suggested that the observed comorbidity was more pro- nounced in migraineurs experiencing visual disturbances; however, no differences in association with migraine were seen for the two ADHD endophenotypes (inatten- tion and hyperactivity-impulsivity).

The current study significantly supplements the sparse literature regarding the comorbidity between migraine and ADHD in adults by using a large, healthy study population of individuals who have not been exposed to chronic treatment for migraine or for ADHD.

This was not true for the 10–19 years age group, suggesting that ADHD among adolescents may have no comorbidity with migraine and thus having a distinct etio- pathology or, as previously mentioned, there is a masking of migraine symptoms in young individuals with ADHD.

Conclusion We demonstrate a significant corbobidity between migraine and ADHD in adults, and this is most prominent for participants with migraine with visual disturbances. These results contribute to the understanding of genetic correlation seen between ADHD and migraine and seeds future studies that will elucidate which genetic and environmental factors contribute to migraine-ADHD comorbidity.

Acknowledgement A machine generated summary based on the work of Hansen, Thomas Folkmann; Hoeffding, Louise K.; Kogelman, Lisette; Haspang, Thilde Marie; Ullum, Henrik; Sørensen, Erik; Erikstrup, Christian; Pedersen, Ole Birger; Nielsen, Kaspar René; Hjalgrim, Henrik; Paarup, Helene M.; Werge, Thomas; Burgdorf, Kristoffer. 2018 in BMC Neurology.

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