Migraines. Under Further Consideration
Updated: Aug 21, 2022
Migraines and headaches are connected with other problems like anxiety, depression, concussions ADHD.
Concussions have a connection with migraines and ADHD. Dr. Chayette shared her evaluation of those with frequent recurrent concussions when asked further, and they reported that they used to be able to concentrate better before. The traditional view of ADHD is that they needed prior symptoms. Treatment of those with recurrent concussions with stimulants in the same way one treats ADHD gives similar improvements, including a reduction in post-concussion headaches.
Dr. Cheyette recalls the first patient she had where she connected migraines and ADHD. Sleep affects migraines tremendously, and patient stays up late to complete things they should have completed sooner but didn't do to their undiagnosed and untreated ADHD. This detective work is similar to my observations of ADHD with fibromyalgia. Dr. Cheyette shares that medical specialization can cause problems for optimal patient care. A patient with anxiety and ADHD may see a psychiatrist who doesn't treat migraines and a neurologist for migraines who doesn't recognize, diagnose, or treat ADHD.
There are many different ways that ADHD can worsen headaches, and headaches can worsen ADHD. It is the same brain, but doctors have other interests and training. Similarly, with fibromyalgia, a rheumatologist may diagnose fibromyalgia, the 2nd most common diagnosis they make, but are more comfortable managing specific inflammatory disorders rather than fibromyalgia unless they have taken a special interest.
There has been a recognition in research for years that anxiety was more prevalent in those with headaches, but only recently has the realization of anxiety as a common symptom of ADHD. Some of the questions we traditionally ask of anxiety include restlessness. The depression screening questionnaire, PHQ9, also has questions that overlap with ADHD symptoms. ADHD was thought of as being caused by bad kids and parents. Recognition that the involvement of brain processes is more recent.
A typical patient, "Sally," may be 15 years old with worsening headaches self-medicated with daily high levels of ibuprofen. She starts to miss more and more activities. She sees her doctor, optometrist, and finally, Dr. Cheyette. There was a family history of brain cancer. She was getting six hours of sleep. Her grades declined in high school. She was always worried about things and school. She also was much worse around her period. She always had to work hard to manage in middle school, but the increased academic rigors in high school were increasingly taxing on her brain. She was very chatty, never liked to read, and had adopted the persona of the "ditzy" kid. Sally thought she was smart but had to work harder. She had viewed herself as a very sick person and that she was dying. Sally had a lot of expenses involved in her medical workup. One parent thought she was really suffering, and the other thought she was somewhat of a hypochondriac.
Sally's story is likely familiar to many reading this.
Chronic daily headaches overlap with complex regional pain syndrome. What is the difference between chronic daily headaches, fibromyalgia, and complex regional pain syndrome? They overlap significantly, and many people will be on the continuum with more or fewer organ systems involved and the intensity of symptoms undulating. These will vary based on the levels of different stimuli. Sleep plays a role and consists of sleep quality, quantity, and regularity. Menstrual cycle hormone levels impact symptoms. The amount and consistency of exercise also are essential. Diet can have a powerful impact affected by the levels of fiber, such as the higher amounts in whole plant-based foods compared to a diet higher in processed carbohydrates and animal protein.
What would have happened if "Sally's" comorbid ADHD could have been recognized by her pediatrician through her initial assessment and a comprehensive plan implemented sooner?
No doubt unnecessary pain, suffering, worsening academic performance, family turmoil, distrust in the medical system, and worry she was dying could have been prevented.
Here is one of the studies alluded to by Dr. Cheyette and myself.
You can get connected with the resources below to learn more about fibromyalgia and related problems.
Learn more about Dr. Sarah Cheyette at her website.