an opinion piece by Dr Lysandra Katelaris
Migraine is usually described as a headache disorder. Anyone who treats it regularly knows that it barely captures it.
Migraine is a disorder of the nervous system in which the brain can become extraordinarily sensitive to its internal and external environment. Light becomes painful. Ordinary sounds turn intrusive. Smells are impossible to ignore. Movement, visual complexity, disrupted sleep, hormonal change and the competing stimuli of a busy room can all become difficult to tolerate.
A pattern worth noticing
In migraine practice, another pattern comes up often enough to be worth asking about. A striking number of patients either carry a diagnosis of ADHD or autism, identify with both sets of traits — sometimes described as AuDHD — or describe neurodivergent characteristics despite never having been formally assessed.
Often these emerge only as the consultation unfolds: lifelong sensory sensitivities, difficulty filtering competing stimuli, executive-function difficulties, intense interests, a need for predictability, or simply becoming overwhelmed by environments that other people appear able to tune out. Explore the family history and similar traits frequently appear in parents, siblings or children.
None of this means migraine implies neurodivergence, or the reverse. But it raises a genuinely interesting question: could migraine and neurodivergent traits, in some people, reflect overlapping differences in how the brain processes, filters and responds to information?
The association is real. The explanation is not.
The evidence is strongest for ADHD, where population studies and systematic reviews have consistently found more headache and migraine. Migraine and autism have been studied less extensively, though emerging research also suggests an association. Large genomic studies add another piece, identifying genetic correlations between migraine and ADHD, and to a lesser extent autism.
This is not a "migraine-neurodivergence gene", and it does not mean one condition causes the other. Both are complex and heterogeneous. It does suggest some of their biological architecture may overlap.
The brain is constantly deciding what matters
At every moment the nervous system processes an enormous volume of information — light, sound, smell, touch, movement and signals from within the body. Most never reaches conscious attention, because the brain filters and prioritises. The useful question is not simply how strongly a stimulus is detected, but how effectively the brain decides: this matters, this does not.
Migraine appears to involve differences in that process. Neurophysiological studies have demonstrated altered responses and habituation to repeated visual, auditory and somatosensory stimuli. This may help explain why migraine is so profoundly sensory a disorder: photophobia, phonophobia and osmophobia are not incidental accompaniments to headache but, for many people, central features of it.
Sensory-processing differences are also common in autism and can occur in ADHD. Background conversation stays in the foreground. Fluorescent lighting cannot be ignored. A crowded room demands enormous cognitive effort. The parallels are compelling, but similar experiences do not necessarily mean identical biology.
Beyond the diagnostic boxes
Most research understandably begins with diagnoses. Clinical practice suggests a different question: what about the traits themselves?
Neurodevelopmental characteristics exist dimensionally. Nobody needs to meet criteria for ADHD or autism to have meaningful differences in sensory processing, attention or executive function. This may be particularly relevant for adults who grew up when these conditions were recognised far less often, and for women whose differences were overlooked or quietly compensated for across many years — including those who only recognise the traits in themselves after a child is diagnosed.
Why it matters in the consulting room
Migraine management asks a great deal: regular medication, consistent sleep and meals, exercise, appointments, prescriptions, headache diaries and recognising patterns over time. For someone with significant executive-function difficulties, an elaborate plan may fail not because the treatment is ineffective, but because the plan itself is neurologically difficult to implement.
Similarly, someone overwhelmed by fluorescent lighting, background conversation and unpredictable environments cannot simply "avoid triggers" without avoiding large parts of ordinary life.
Understanding an individual's sensory and cognitive profile allows migraine management to be designed around the person, rather than expecting the person to fit the management.
Migraine has already taught us that pain is only one part of how the brain experiences an attack. Studying it alongside neurodivergence may teach us something broader — not simply why some brains develop migraine, but why some brains experience the world more intensely in the first place.
For people living with migraine, this means considering how each brain responds to the outside world — including sensory load, attention, routine, sleep and everyday demands.
The more we understand these individual differences, the better we can tailor treatment to each person for reduced migraine days and better quality of life.
Author: Dr Lysandra Katelaris
Adult Neurologist and Neurophysiologist at Neurology Castle Hill