Autism/Autism Spectrum Disorder (ASD): Differentiation and Treatment Management of Migraine and Headache
People with autism/autism spectrum disorder (ASD) may experience various types of headaches, and studies have shown that the prevalence of migraine in ASD patients is higher than that in non-autistic
People with autism/autism spectrum disorder (ASD) may experience various types of headaches, and studies have shown that the prevalence of migraine in ASD patients is higher than that in non-autistic patients. Studies estimate that approximately 50% or more of ASD patients suffer from migraines or frequent headaches. This prevalence is significantly higher than the general population. Like the general population, women are three times more likely to suffer from migraines than men, so autistic women are particularly susceptible to this type of headache. Migraines and tension headaches are the most common types of headaches in the ASD patient population, and the chances of migraines are higher than those of tension headaches.
Description of headache types in patients with autism/autism
Main types of headaches in patients with ASD
Migraine: characterized by moderate to severe throbbing pain, often accompanied by sensitivity to light and sound, nausea, and visual disturbances. Migraines can seriously affect daily function and may require specific treatment under the diagnosis of a professional doctor.
Timely diagnosis is essential to avoid debilitating consequences. Migraine aura is a sensory symptom (neurological, gastrointestinal, and autonomic) that may occur before or during a migraine attack. These symptoms may include visual flashes, blind spots, or tingling in the hands or face. When stimulated, nerves send electrical signals to the brainstem, which connects to nerves in the cortex and its covering, the dura mater.
Tension headaches: Often described as a dull ache around the head or neck. Tension headaches can be caused by muscle tension or stress and can vary in intensity. People with autism may be more susceptible to tension headaches due to heightened sensory sensitivities and emotional factors.
They are often called "hatband" headaches because they usually ache around the back of the head, temples, and forehead, like wearing a tight hat. Tension-type headaches (TTH) are recurring headaches that last from a few minutes to a few weeks. The pain is usually compressive or tight in nature, mild to moderate in intensity, and bilateral in location, and is not worsened by daily physical activity. Nausea and vomiting are not usually present, but photophobia or phonophobia may be present. Tension headaches can coexist with migraines, and one headache can transform into or trigger the other. Tension headaches often respond to physical therapy, relaxation therapy, and anti-inflammatory medications or muscle relaxants.
Sinus headaches: Sinus headaches are characterized by pain or pressure in the forehead, cheeks, eye sockets, eyebrows, or bridge of the nose. These headaches may be headache-only and not accompanied by sinusitis symptoms. Sinus migraines occur due to overactivity of the trigeminal nerve and the autonomic nervous system. The first branch of the trigeminal nerve is responsible for the head pain caused by migraines, but the second branch connects to sensors in the sinuses, which can cause pressure and pain in the forehead, behind the eyes or in the nose, and under the cheeks, mimicking some of the symptoms of sinusitis.
Cluster headaches:
Understanding the prevalence of headaches in autism and recognizing common headache types can help patients and their families seek appropriate support and develop personalized interventions. Attacks typically last 15 minutes to 3 hours and occur from once every other day to 8 times a day. These frequently recurring attacks occur in clusters (cluster periods), usually separated by periods of symptom-free remission, which often last for several months. There are diurnal and seasonal differences in the frequency of attacks, with higher frequencies at night and in spring and autumn. Phonophobia and photophobia in cluster headaches occur unilaterally (usually on the side with pain), while in migraines, phonophobia and photophobia occur bilaterally.
Symptoms of headaches in patients with autism spectrum disorder (ASD)
Sensory impairment: Many patients will experience sensory impairment, such as sensitivity to light, sound or smell. Some patients may also experience visual impairment, such as seeing flashes or blind spots, due to the sudden need to be in a dark and quiet space (photophobia and phonophobia).
Severe headaches: Young patients usually experience severe headaches and strong irritability. Some children even show aggressive or self-harming behaviors. Headaches may last for hours or even days, which may make patients more withdrawn or irritable and difficult to concentrate. These headaches are usually aggravated by physical activity and may be accompanied by dizziness, nausea, abdominal pain or vomiting. Child patients will repeatedly touch or hit their heads, use their heads to press against the wall or other hard objects to press on the head and nose bridge, and bite clothes, pillows and the back of the hand when they have a headache.
Fatigue and mood changes: Headaches can cause fatigue and mood changes in patients, including irritability, depression or anxiety, which can seriously affect daily functions. Some autistic children do not have the habit of taking naps, so they feel tired between 5 and 6 in the evening. Many patients are prone to headaches during this period.
Sleep disorders: Headaches can disrupt patients' sleep patterns. Children with ASD may have difficulty falling asleep or frequently wake up and cry at night
Phantom tooth pain: Many headache patients have trigeminal nerve conduction problems. Trigeminal neuralgia can cause pain in the upper teeth of patients. Some children still have unresolved pain after tooth extraction or root canal treatment
Relaxed satisfaction: Sometimes after the headache attack ends, children will show a happy and relaxed satisfaction
It is worth noting that not all autistic children will show the same signs and symptoms. Headaches vary in manifestation, and some children may not be able to express their pain or the type of experience in words. Therefore, parents need to closely observe their children's behavior and consult a professional doctor if they suspect that their children have headache symptoms.
Some common symptoms of autism and migraines
Sensitivity to light and sound: People with autism and migraines may both be highly sensitive to light and sound, which may exacerbate their symptoms.
Headaches: Both conditions can cause headaches, although the nature and intensity of the headaches may vary. People with autism may have difficulty expressing their pain or describing the feeling of a headache, so healthcare providers must consider their unique communication style.
Disrupted sleep patterns: Both autism and migraines can disrupt sleep patterns, making it difficult to fall asleep or stay asleep. This can lead to increased fatigue and worsening of other symptoms.
Difficulty in diagnosis
Diagnosing migraine in children with autism can be complicated due to a variety of factors. These challenges may include:
Communication difficulties: Children with autism may have difficulty accurately expressing their symptoms or describing their pain. They may have limited verbal communication skills or difficulty expressing themselves, making it more difficult for parents and healthcare professionals to identify migraine.
Symptom overlap: Migraine symptoms may overlap with core symptoms of autism, such as sensory sensitivity and behavioral changes. Distinguishing these symptoms can be tricky and may require careful observation and tracking of patterns.
Nonverbal children: Nonverbal children with autism face additional challenges in expressing pain or discomfort. Parents and healthcare professionals must rely on other communication methods, such as observing behavioral changes or using visual aids, to assess the presence of migraine.
Limited research: Despite the growing recognition of the link between autism and migraine, research specifically focusing on migraine in children with autism remains limited. The lack of research may make the diagnosis and effective treatment of migraine more difficult.
By understanding the common signs and symptoms of migraine in children with autism and understanding the challenges of diagnosis, parents can take proactive steps to effectively address their child's migraine symptoms. Early identification and management can significantly improve the quality of life for children and their families.
二、Causes of migraine/headache in patients with ASD
Sensory Sensitivity: Both autism and migraines are associated with heightened sensory sensitivity. People with autism and migraines may be more prone to sensory overload, which may trigger or worsen migraines. Bright lights, loud noises, strong smells, or certain textures can all contribute to sensory overload. Identifying and managing sensory triggers is important to reduce the likelihood of headaches.
Comorbid conditions and medications: People with autism often have co-occurring conditions such as anxiety, depression, or epilepsy, which can increase a person's likelihood of experiencing headaches. Medications used to treat these conditions may also have side effects that can cause headaches. Doctors need to carefully evaluate the potential side effects of medications prescribed for people with autism. If headaches are a side effect of certain medications, alternative treatment options or dosage adjustments may be considered. Consulting with a healthcare provider who has experience treating people with autism is essential to ensure the best management approach.
Several other potential triggers: These can include changes in routine or schedule, dehydration, lack of sleep, hormonal changes (such as menstruation) and stress or anxiety, alcohol and smoking, high altitude (hiking and air travel), bright light (including sunlight), physical activity (physical activity), heat (hot weather or hot showers), major weather changes (especially when there are cold fronts with changes in barometric pressure), foods high in nitrites (bacon and cured meats), certain medications, cocaine, etc. It is important to keep track of any potential triggers and make adjustments as needed to help manage symptoms.
Causes of headache symptoms in autism patients: IEM
Many inherited metabolic disorders (IEM) can cause headache symptoms, such as mitochondrial disorders (POLG, NARP, MERRF, MELAS, Leigh), celiac disease, methylmalonic acid combined with homocysteine, and acute hyperammonemia in urea cycle disorders.
Causes of ASD: inherited metabolic disorders IEM
1、常见的遗传代谢障碍疾病（IEM）的类型：
小分子疾病:（1）蛋白质（氨基酸）代谢障碍类疾病和有机酸血症；（2）碳水化合物代谢障碍；(3)脂肪酸代谢障碍；(4)卟啉、血红素代谢障碍；(5)矿物质吸收和运输障碍。
细胞器类疾病：(1) 溶酶体和溶酶体相关细胞器疾病 (2) 过氧化物酶体疾病；（3）线粒体脑肌病。
其他：（1）嘌呤、嘧啶及神经递质代谢疾病 (2)维生素及非蛋白质辅因子代谢及转运障碍； (3)能量代谢障碍；（4）胆固醇合成与代谢障碍 ，（5）肌酸代谢障碍
IEM的类型与诊断可以查看往期文章：
SWAN无名综合征（疑似遗传性代谢病）的代谢性急症表现、评估和治疗
血氨、血糖、血脂、乳酸、血气分析、脑脊液分析
2、IEM相应的生化体征和症状表现这些体征和症状被分为多个器官系统和病症（自主系统、心血管、牙科、皮肤科、消化系统、畸形、耳朵、内分泌、眼睛、泌尿生殖系统、头发、血液、免疫、代谢、肌肉、神经、精神、肾脏、呼吸、骨骼、肿瘤等）2.1 神经性进食障碍（厌食症与饮食回避）：刻板单一饮食习惯 ； 回避/限制性食物摄入障碍ARFID ； 线粒体神经胃肠脑肌病（MNGIE）偏头痛的并发症：肠易激综合症IBS2.2 癫痫病症：IEM引起的癫痫病症2.3 脑瘫表型：痉挛型（包括双瘫、偏瘫和四瘫）、不随意运动型（包括肌张力障碍和舞蹈手足徐动症）、共济舒缓型
2.4 精神异常疾病：抑郁症、自闭症、认知障碍、老年痴呆
2.5 运动障碍疾病：肌张力障碍、肌阵挛、舞蹈症、震颤、抽动、帕金森症或共济失调、眼球运动障碍、进行性肌阵挛癫痫、中风和中风样发作
2.6 代谢性肌病：肌肉无力、张力减退、运动不耐受、肌红蛋白尿（酱油尿）、横纹肌溶解症
2.7 代谢性肾脏疾病：肾小管、肾小球、肾囊肿、肾结石、肾畸形
2.8 代谢性肝病MLD：肝肿大；伴有转氨酶升高或明显急性肝功能衰竭的肝细胞疾病；胆汁淤积; 脂肪变性；纤维化或肝硬化；和肝脏肿瘤
2.9 肠胃消化道GI病症：没胃口、胃食管括约肌功能障碍、便秘、吞咽困难、呕吐、胃轻瘫、假性肠梗阻、腹泻、胃肠道空腔器官的罕见表现、胰腺炎、肝病
2.10 呼吸道系统疾病病症：间质性肺病、下呼吸道感染、慢性气道抽吸、肺动脉高压、肺泡通气不足、上呼吸道阻塞
2.11 免疫缺陷：先天性免疫与适应性免疫
2.12 代谢性耳病：感音神经性听力损失、混合性听力损失、先天性外耳异常、先天性外耳异常、内耳或耳蜗后受累
2.13 代谢性眼科疾病：色素性视网膜炎 (RP)、无脉络膜血症、斯塔加特病、锥杆营养不良症 (CRD)、莱伯先天性黑蒙 (LCA)
2.14 CVI脑皮质视觉障碍（皮质盲）：视而不见失认症、视野缺失、视觉刺激
2.15 肿瘤：有毒代谢物的积累、肿瘤代谢物、线粒体功能障碍、代谢重组
2.16 代谢性皮肤病与毛发异常：丘疹、皮肤结节、结节性黄瘤、黑色素沉着、光敏性皮炎、糙皮病、肠病性肢端皮炎、血管角化瘤、短、稀疏和/或脆弱的头发、结节性脱发
2.17 代谢性心血管疾病：心肌病、心律失常、血管疾病、心脏代谢
下列合集将此类以眼科、肌病、精神异常等临床病症为代表的遗传代谢病系列汇总在这个合集并持续更新，希望给未经确诊的患者一些临床提示，希望患者家属将这些蛛丝马迹的病症汇总给专业的代谢医生分析，争取早日确诊，得到规范治疗，从而避免疾病引起的继发性脏器损伤，以及家族相关疾病预防与再生殖预警。
合集：
IV. Diagnosis of headache symptoms in patients with autism
Diagnosing autism and migraine requires a comprehensive evaluation by a healthcare professional with expertise in these areas. The diagnostic process typically includes:
History: Collect detailed information about the individual's medical history, including any previous diagnoses, symptoms, and family history of autism or migraine.
Clinical interview: Interviews with the individual and their caregivers to collect information about the individual's experiences, behaviors, and symptoms related to autism and migraine.
Behavioral observation: Observe the individual's behavior and interactions in different settings to identify any characteristic symptoms related to autism and migraine.
Standardized assessments: Standardized tests and questionnaires are administered to assess the individual's developmental, social, and cognitive functioning. In addition, specific assessments may be used to assess the symptoms and severity of migraine.
Collaborative assessments: In some cases, multiple professionals from different fields (such as neurology and developmental pediatrics) may collaborate to ensure a comprehensive evaluation.
Testing: Brain and heart vascular CT, eye MRI, or CT may be performed for some patients with visual auras. Patients with visual auras need to pay attention to: Migraine and stroke: common pathways, mechanisms and risk factors
24-hour EEG test: EEG evaluation can consider the choice of epilepsy drugs in subsequent treatment drugs
There are also some related tests for the diagnosis of IEM, a genetic metabolic disorder mentioned above. Accurate diagnosis and evaluation are essential to understand the unique needs and challenges of patients with autism and migraine. This information forms the basis for developing an effective treatment plan.
V. Treatment Management Recommendations
When treating headaches/migraines in people with autism, parents must use a variety of strategies to relieve symptoms and improve their child's quality of life. This article will explore three key areas of treatment: communication and sensory strategies, medication selection and precautions, and preventive lifestyle adjustments.
Communication and sensory strategies
Coping with sensory sensitivity:
Sensory sensitivity is a common challenge for people with autism and can lead to headaches and migraines. To help manage sensory overload, people with autism can adopt several strategies:
Wear noise-canceling headphones or earplugs in noisy environments
Wear sunglasses or hats to reduce exposure to bright light
Avoid strong smells or use unscented products
Incorporate sensory breaks into daily life, such as resting quietly in a calm space
Communication and visual support: Using visual supports, such as visual timelines or social stories, can help people with autism understand and express their migraine symptoms. Implementing alternative communication methods, such as picture cards or assistive technology, can help communicate effectively during a migraine attack. When watching videos, you can slow down the playback speed to reduce the patient's visual stress, and visual supports can provide a sense of structure and reduce anxiety.
Medication selection and precautions (this article is only for disease content popularization. Please consult a doctor for medication treatment and do not take medication on your own)
It is essential to consult a doctor for medication and medical intervention in autism and migraine. They can provide appropriate medication selection or medical intervention guidance to control migraines, taking into account the unique needs and sensitivities of autistic patients.
Supplement selection: Because some patients with migraine have mitochondrial disorders, it is clinically recommended to supplement riboflavin, coenzyme Q10, and magnesium. Riboflavin and coenzyme Q10 are important supplements for mitochondrial cocktail therapy.
原发性线粒体疾病PMD用于激活代谢通路或供能的辅酶、酶辅助因子、抗氧化剂的鸡尾酒疗法
Magnesium is one of the most well-researched supplements for migraine prevention. One study found a correlation between low magnesium levels and migraines, leading to the belief that magnesium deficiency may be a risk factor for migraines. Magnesium deficiency is thought to cause cortical spreading depression, which may be responsible for the aura phenomenon associated with migraines.
Medication: There are no medications specifically for migraines or headaches in people with autism. However, some healthcare providers may prescribe medications commonly used to treat migraines, such as triptans or beta blockers. Some prescription medications for migraines work best if they are taken before the person notices an aura, but some people with autism may not be able to communicate the aura, so close parental observation is sometimes required.
Monitor and track: Keep a record of your child's migraine attacks, medication use, and any observed changes in symptoms. This information can help the doctor make adjustments to ongoing treatment.
Preventive lifestyle adjustments
Prevention plays a vital role in treating migraines in children with autism. Taking steps to minimize triggers and promote overall health can significantly reduce the frequency and severity of migraine attacks. Consider the following lifestyle adjustments:
Establish a routine: Creating a consistent daily routine for your child, including regular and adequate sleep patterns, meals and activities, and ensuring adequate sleep can reduce the frequency and intensity of headaches. It is essential to create a quiet and comfortable sleeping environment, and you can wear sunglasses when you go out in the strong sunlight. Maintaining a sense of stability and predictability can help reduce stress and prevent potential triggers.
Sensory-friendly environment: Create a quiet, sensory-friendly and comfortable environment during migraine attacks, minimizing bright lights, loud noises and strong smells that may exacerbate symptoms. Strategies such as providing a quiet, dimly lit space and using sensory tools such as headphones or sunglasses can help people with autism minimize sensory overload, and resting in such a friendly environment can help relieve discomfort.
Gluten-free diet, dairy-free diet (allergies need to be excluded): Some people with autism may find that certain foods or additives trigger headaches. Keeping a food diary and identifying potential triggers can guide dietary adjustments.
Stay hydrated: Dehydration is a common trigger for headaches/migraines. Encourage people with autism to drink water throughout the day to stay hydrated. Consider electrolyte drinks when you are more active or when the weather is hot. Electrolyte drinks such as coconut water or sports drinks can help maintain proper hydration and body electrolyte levels.
Identify triggers: Keep a migraine diary to record potential triggers for your child's migraines. These triggers may vary from person to person and may include factors such as certain foods, environmental stimuli, or changes in daily life. Identifying and avoiding triggers can reduce the likelihood of migraine attacks.
Migraine diary: You can record the type of food you eat every day, weather, temperature, air pressure, time period and number of migraine attacks, other symptoms: eye symptoms, nystagmus, blurred vision, and observe and record the patient's headache area, which can help doctors determine the type of headache the patient has, and can also help patients find the types of foods that trigger headaches.
Develop healthy habits: Encourage your child to maintain a healthy lifestyle, exercise regularly, eat a balanced diet, and stay hydrated. These habits contribute to overall health and may reduce the occurrence of migraines.
Stress management techniques: Teaching stress management techniques, such as deep breathing exercises, mindfulness, or relaxation techniques, can help people with autism and migraines cope with stress and reduce the likelihood of migraine attacks.
SWAN无名综合征（疑似遗传性代谢病）的代谢性急症表现、评估和治疗
自闭症/孤独症谱系障碍ASD的补充疗法-生物疗法的概述与建议
关于遗传代谢障碍疾病IEM与自闭症/孤独症的介绍可以查看下列合集：
往期合集：
遗传代谢诊断检测：血尿串联质谱、血气、乳酸、血氨、肝肾功能等