“What Years of Debilitating Migraines Taught Me About ADHD in Women”

Before I was diagnosed with ADHD at age 33, my body felt like a mystery, an experience I assume is nearly universal for women with a late diagnosis. Yes, there was forgetfulness, distractibility, “careless” errors, internal restlessness, and emotional dysregulation. Yes, there were incredibly painful menstrual cycles with mood changes so drastic they should have their own amusement park rides named after them. But there were also migraine headaches so severe that they’d often lead me to hide in the bathroom and vomit while working a retail job at age 20.

Despite the unbearable pain and nausea associated with migraines, I attended regular work and school hours. With then-undiagnosed ADHD, untreated migraines, severe mood swings, and an unpredictable body, I completed all of my responsibilities with a smile on my face, masking the feeling of being a walking zombie. Experiencing – or rather, trying to act like I wasn’t experiencing any of it – was likely a big reason why I was diagnosed with depression before I was diagnosed with ADHD.

All Roads Lead Back to Estrogen

After my ADHD diagnosis, I poured myself into research, as I quickly learned I would need to educate myself about ADHD’s unique presentation in women. One finding that struck me was just how much hormonal fluctuations influence ADHD symptoms in women, which complicates an already-complicated picture. The villain causing all of my challenges, it seemed, was low estrogen levels.

[Get This Free Download: Hormones & ADHD in Women]

It turns out that there’s a strong relationship between estrogen and dopamine, which is one of the main neurotransmitters involved in ADHD. Low estrogen levels mean low dopamine levels. The inverse is true. When we consider that there are predictable drops in estrogen throughout the female lifespan, like right before getting a period or during perimenopause, to name a few, it means there’s a predictable worsening of ADHD symptoms, too. Low estrogen levels seem to hit us hard, which may be why premenstrual mood disorder (PMDD), a severe form of premenstrual syndrome (PMS), disproportionately affects women with ADHD.¹

But that’s not all. Low estrogen levels are also known to trigger migraines.² Could this connection explain why migraines, which are more prevalent in women, co-occur with ADHD about 35% of the time?³ As I tried to put the pieces together, I felt like a detective uncovering the mystery of my life. I finally understood why I felt so out of my body and mind in the midst of a migraine attack. I understood why, on migraine days with yet undiagnosed ADHD, it felt like there was an ineffective replacement version of me steering the ship, and the vessel that was me was constantly on the verge of collapse.

Silent Conditions

As I tried to learn more about the migraines-ADHD connection in women, I learned that, as with ADHD, research on migraines and the scientific attention given to migraines are biased with respect to gender. In Migraine: Inside a World of Invisible Pain (#CommissionsEarned), Maria Konnikova writes that, despite the disease’s prevalence, migraines receive little to no attention in medical schools. Further, Konnikova explains that Sigmund Freud can be thanked for the gender divide in migraine diagnosis. If women are suffering, it must be, quite literally, an unobservable, unexplainable phenomenon in their heads. Like ADHD, migraines are a silent and overlooked condition in women. As with my own ADHD diagnosis journey, I suffered from migraine headaches for years before going to a neurologist to finally get them treated.

[Read: Hormonal Changes & ADHD — a Lifelong Tug-of-War]

Invisible No More

In her 1968 essay “In Bed,” Joan Didion writes that the public often views migraines as “imaginary.” I argue that ADHD is often viewed similarly in women. And why wouldn’t this be the case? As long as we mask our pain and our symptoms — a habit I’m still unlearning — ADHD in women will continue to be difficult to detect. As long as the medical community dismisses the relationship between hormonal fluctuations and ADHD, women will go misdiagnosed and improperly treated.

Here’s the truth: Women with ADHD, like women with migraines and other conditions heavily tied to hormonal and dopamine imbalances, are boiling pots with ill-fitting lids that we and the people around us use to avoid being misperceived as untamed shrews. And I’d venture to guess you’re just as tired of acting as I am. Regardless of the condition, we deserve to have all of our symptoms taken seriously.

ADHD in Women: Next Steps

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