Pain is a warranted worry for parents of children with autism spectrum disorders. Communication impairments could mean children struggle to put pain in words, meaning serious conditions and symptoms may be missed. With more autistic adults searching out advice about headache disorders, the association between autism and migraines deserves a closer look.
My child banged his head on the floor hard, repeatedly, and deliberately…it was one of the most upsetting things I’ve ever witnessed. This sentiment is often shared hesitantly by parents of children with autism spectrum disorders. Some believe sensory processing issues lead to the behavior, others speculate about inflammation, or “a brain in pain”.
A brain in pain
Head banging, meltdowns, and other behaviors lead to parents wondering if their child may be in pain. Communication challenges, especially for nonspeaking/nonvocal kids, add to the worry—what if a child with autism spectrum disorder is suffering from severe pain, such as chronic headaches, and struggling to ask for help?
Parents worried about migraines in their children may want more information about the painful condition—especially research exploring prevalence in the pediatric autistic population. Migraines and other headache disorders are diagnosed and treated by medical professionals; these conditions should never be self-diagnosed, or treated without consulting your child’s pediatrician or psychiatrist.
Migraine headache
Sometimes the word migraine is erroneously used to refer to an intense headache. Migraines are not bad headaches, they can be a serious neurological disease, with various symptoms, requiring differing intervention and treatment. Migraine auras (another word that often causes confusion) are the sensory symptoms, like flashes of light, that happen before, during, or after a migraine.
Symptoms of the headache disorder in children include, but are not limited to:
- Pain (front or sides of head) throbbing or pounding in nature
- The pain is significant, to the degree of interfering with activities
- The head pain may be aggravated with physical activity
- Loss of appetite, nausea, or even vomiting may accompany the head pain
- Extreme sensitivity to light, smell, and sound
While we need more research delving into the possible link between autism spectrum disorder (ASD) and migraine headaches, a recent study seemed to confirm ASD as an independent risk factor for migraine (Lee et al., 2021). Results from the study show:
- Compared to those without ASD, children and adolescents on the spectrum were more likely to develop migraine later in life
- ASD was found to be an independent risk factor for migraine (after accommodations for psychiatric and medical comorbidities, children and youth with autism had a significantly higher risk of developing migraine compared to those without ASD)
- The risk seemed particularly significant in males on the spectrum
The link between autism spectrum disorders and migraines
When researching the association between autism and migraines, sensory processing impairments, anxiety, and inflammation are prominent areas where ASD and migraine headaches seem to converge.
Sensory processing impairments
A systematic review (Dellapiazza et al., 2018) revealed atypical sensory processing was reported in 82% to 97% of participants with autism. Parents frequently report hypersensitivity and/or hyposensitivity in their children on the spectrum; anecdotal evidence reveals sensory input and stimuli have a major influence on the behavior and well-being of autistic individuals.
Research (Genizi et al., 2019) also showed the prevalence of sensory processing difficulties are significantly higher in children with migraine in comparison to healthy controls. The study further suggested sensory processing difficulties correlate with lower quality of life among children with migraine.
Increased pain sensitivity is an important aspect of sensory processing difficulty that may be a factor linking migraines to autism. Most migraineurs have symptoms of somatosensory hypersensitivity during migraine episodes (Schwedt, 2013). An increased sensitivity to pain, or a lower pain threshold, seems to be shared by those on the spectrum and migraineurs (Blau & Solomon, 1985). A brain overreacting to pain with limited means of communicating discomfort may be the reality of many autistic children.
Anxiety
In the general population, migraine headaches seem to be associated with sensory hyperreactivity and anxiety; a study (Sullivan et al., 2014) showed preliminary evidence of a link between migraine headaches, sensory overreactivity and anxiety symptoms in children with ASD.
A strong and consistent association between anxiety and migraines (Karimi et al., 2021) has been confirmed. Furthermore, high prevalence of anxiety disorders in autistic youth is well established (Vasa & Mazurek, 2015). Symptoms of anxiety, like excess worry and fear, may be part of the “migraine clinical spectrum”—conversely, head pain could also be part of the “anxiety clinical spectrum” (Peres et al., 2017).
A child on the spectrum with atypical perception of pain may experience headaches differently, more intensely in comparison to neurotypical peers. Adding to the challenge of a low pain threshold, anxiety symptoms increase the likelihood of headache disorders in autistic kids.
Inflammation
Dr. Theoharis Theoharides, an Autism Parenting Summit speaker, published research pertaining to mast cells (cells that are involved in immune response and allergy reactions) and their role in neuroinflammation. Mast cells and the secretion of inflammatory molecules could contribute to the development of ASD and migraines (Theoharides et al., 2016).
Autism often co-occurs alongside other conditions or disorders: obsessive compulsive disorder, seizure disorder, bipolar disorder and other such conditions are not only associated with autism but also migraine headaches. More research is needed to understand the links between these conditions. Parents suspecting any neurological or neurodevelopmental issues should consult with a qualified medical specialist as soon as possible.
Severe pain, limited means of communication
Armed with knowledge of the possible link between autism and migraines, parents should be alert to any behavior or communication attempt of a child struggling with a tension type headache or even migraine. Common parent-reported symptoms leading to seeking of evaluation include the child not acting like themselves, irritability, and feeding intolerance (Quinn et al., 2018).
For nonspeaking/nonvocal children, behavior may provide clues that a child needs to be medically evaluated for a headache disorder. Encouraging and teaching children to share discomfort, visually or verbally, will help a child feel safe, knowing caregivers can be alerted to pain.
References:
Blau, J. N., & Solomon, F. (1985). Smell and other sensory disturbances in migraine. Journal of neurology, 232(5), 275–276. https://doi.org/10.1007/BF00313864.
Dellapiazza, F., Vernhet, C., Blanc, N., Miot, S., Schmidt, R., & Baghdadli, A. (2018). Links between sensory processing, adaptive behaviours, and attention in children with autism spectrum disorder: A systematic review. Psychiatry research, 270, 78–88. https://doi.org/10.1016/j.psychres.2018.09.023
Genizi, J., Halevy, A., Schertz, M., Osman, K., Assaf, N., Segal, I., Srugo, I., Kessel, A., & Engel-Yeger, B. (2019). Sensory Processing Difficulties Correlate With Disease Severity and Quality of Life Among Children With Migraine. Frontiers in neurology, 10, 448. https://doi.org/10.3389/fneur.2019.00448.
Karimi, L., Wijeratne, T., Crewther, S. G., Evans, A. E., Ebaid, D., & Khalil, H. (2021). The Migraine-Anxiety Comorbidity Among Migraineurs: A Systematic Review. Frontiers in neurology, 11, 613372. https://doi.org/10.3389/fneur.2020.613372.
Lee, Ting-Yi & Tsai, Shih-Jen & Chen, Yu-Chun & Chen, Mu-Hong. (2021). Risk of migraine development among children and adolescents with autism spectrum disorder: A nationwide longitudinal study. Research in Autism Spectrum Disorders. 89. 101880. 10.1016/j.rasd.2021.101880.
Peres, M., Mercante, J., Tobo, P. R., Kamei, H., & Bigal, M. E. (2017). Anxiety and depression symptoms and migraine: a symptom-based approach research. The journal of headache and pain, 18(1), 37. https://doi.org/10.1186/s10194-017-0742-1.
Quinn, B. L., Solodiuk, J. C., Morrill, D., & Mauskar, S. (2018). CE: Original Research: Pain in Nonverbal Children with Medical Complexity: A Two-Year Retrospective Study. The American journal of nursing, 118(8), 28–37. https://doi.org/10.1097/01.NAJ.0000544137.55887.5a.
Schwedt T. J. (2013). Multisensory integration in migraine. Current opinion in neurology, 26(3), 248–253. https://doi.org/10.1097/WCO.0b013e328360edb1.
Sullivan, J. C., Miller, L. J., Nielsen, D. M., & Schoen, S. A. (2014). The presence of migraines and its association with sensory hyperreactivity and anxiety symptomatology in children with autism spectrum disorder. Autism : the international journal of research and practice, 18(6), 743–747. https://doi.org/10.1177/1362361313489377.
Theoharides, T. C., Stewart, J. M., Panagiotidou, S., & Melamed, I. (2016). Mast cells, brain inflammation and autism. European journal of pharmacology, 778, 96–102. https://doi.org/10.1016/j.ejphar.2015.03.086.
Vasa, R. A., & Mazurek, M. O. (2015). An update on anxiety in youth with autism spectrum disorders. Current opinion in psychiatry, 28(2), 83–90. https://doi.org/10.1097/YCO.0000000000000133.
