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Migraine, Asthma, Mood Disorder and Comorbid Adult ADHD
Migraine, Asthma, Mood Disorder, and Comorbid Adult ADHD
Ole Bernt Fasmer, MD, PhD
Professor, Department of Clinical Medicine, University of Bergen, Norway
First published in Psychiatry Weekly, Volume 7, Issue 6, March 19, 2012
This interview was conducted on January 31, 2012 by Lonnie Stoltzfoos
Introduction
Comorbidities are highly prevalent in both pediatric and adult ADHD. Nearly 70% of children with ADHD have at least one psychiatric comorbidity or neurodevelopmental problem, learning disorders being the most common.1 In adults with ADHD, nearly 40% have a comorbid mood disorder, compared with 11% of adults without ADHD.2 More studies are also finding interesting and rather unexpected links between adult ADHD and migraine, and even asthma.
ADHD and Asthma
Dr. Ole Bernt Fasmer has published several studies on comorbidities of adult ADHD, using Norwegian prescription data from 1997–2005. In Norway, permission from a local regulatory board is required for prescribing ADHD medications, so prescription rates hew closely to diagnosis rates, and comorbidity data are readily available.
“I have been working for many years with ADHD patients and have been part of the committee that gives doctors permission to prescribe for ADHD,” says Dr. Fasmer. “Over time it became my distinct impression, hearing doctors describing their ADHD patients, that ADHD and asthma could be somehow linked, so we started to look into that.”
Indeed, Dr. Fasmer and colleagues have since found that patients receiving either ADHD treatment or anti-asthma treatment had a 65% greater chance of receiving both treatments simultaneously (OR=1.65).3 Receiving both treatments was most strongly associated with women 20–49 years of age and men 30–49 years of age.
“Such a comorbidity between two very different disorders is, of course, intriguing,” says Dr. Fasmer. “It may be related to a common comorbidity with mood or anxiety disorders, but it is also possible that smoking or passive smoking may be a causal factor.”
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ADHD and Migraine
In another study also examining ADHD and comorbidity, Dr. Fasmer and colleagues collected data from approximately 600 adult ADHD patients and 700 controls concerning symptoms of mood disorders, and also asthma and migraine. Migraine was of particular interest because of the strong relationship between ADHD and mood disorders, which, in turn, are strongly associated with migraine.
“When we did this study on ADHD, we thought perhaps we might find more migraine comorbidity, since we know that ADHD is associated with mood disorders,” says Dr. Fasmer.
In fact, Dr. Fasmer and colleagues found that, among men with ADHD, nearly 23% experienced migraine, compared to 11% of controls (P=0.001). In women with ADHD, 34% experienced migraine, compared to 25% of controls (P=0.008). A lifetime history of mood disorder or alcoholism was far higher in patients than in controls. Patients also had relatively less education and poorer employment status.
The strong correlation between ADHD and mood disorders is of particular interest to Dr. Fasmer. “We have one calculation from these data that we didn’t present, because we did it after we published the study,” he explains. “We did a logistic regression and controlled for mood disorders, in which the difference in migraine prevalence between ADHD subjects and controls disappears entirely, so we think that this association between ADHD and migraine is mediated by a mutual comorbidity in mood disorders. Of course we cannot be absolutely sure, but that is our hypothesis.”
Disclosure: Dr. Fasmer reports no affiliations with, or financial interests in, any organization that may pose a conflict of interest.
References:
1. Larson K, Russ SA, Kahn RS, Halfon N. Patterns of comorbidity, functioning, and service use for US children with ADHD, 2007. Pediatrics. 2011;127:462-470.
2. Kessler RC, Adler L, Barkley R, Biederman J, Conners CK, Demler O, et al. The prevalence and correlates of adult ADHD in the United States: results from the National Comorbidity Survey Replication. Am J Psychiatry. 2006;163:716-723.
3. Fasmer OB, Riise T, Eagan TM, Lund A, Dilsaver SC, Hundal O, et al. Comorbidity of asthma with ADHD. J Atten Disord. 2011;15:564-571.