Migraine is a primary, disabling headache disorder characterized by dysfunction in specific sensory and neurotransmitter circuits. In the context of *Autism Spectrum Disorder (ASD)*, there is emerging evidence suggesting that migraine may be more frequent in autistic individuals, with a possible predominance in women, despite the higher incidence of ASD in men (Alsaad, 2024; Vetri, 2020).
Predominance in Autistic Women
Migraine, in the general population, has a strong sex bias, being approximately *three times more prevalent in women* due to hormonal fluctuations, especially *estrogen* fluctuations (Sullivan et al., 2014). In the context of ASD, studies such as that of *Sahito (2021)* indicate a *shared genetic basis between migraine and ASD, highlighting mutations in genes related to serotonergic neurotransmission and calcium channels, such as **CACNA1A* and *HTR2A*, which regulate neuronal excitability and may predispose to both autism and migraine.
Autistic women may be more prone to migraine due to *double biological vulnerability: first, due to the increased risk of females for primary headaches; second, because the female autistic phenotype often involves **sensory hyperreactivity* and greater *dysfunction of dopaminergic and serotonergic regulation*, factors associated with migraine chronicity (Vetri, 2020).
Neurobiology of Migraine in ASD
Migraine in ASD can be explained by *dysfunctions in the thalamocortical networks and in the brainstem-sensory cortex axis, in addition to neuroinflammatory processes. Neuroimaging studies reveal **hyperactivity in the somatosensory cortex and anterior cingulate gyrus*, regions involved in pain modulation and which frequently present dysfunctions in ASD (Canitano & Schröder, 2017).
In addition, there is evidence that autistic individuals present *decreased density of GABAergic inhibitory interneurons, particularly in the **prefrontal cortex* and *insular cortex, resulting in reduced pain modulation capacity and greater vulnerability to migraine attacks. The **dopaminergic and serotonergic systems*, both involved in the regulation of sensory perception and synaptic plasticity, also undergo alterations, contributing to susceptibility to migraine (Sahito, 2021; Sullivan et al., 2014).
Prevalence of Migraine in Autistic People
Data on the prevalence of migraine in autistic individuals are limited, but studies indicate that *approximately 20–35% of individuals with ASD may experience recurrent migraine, a higher percentage than the general population (Alsaad, 2024). In autistic children, migraine may be underdiagnosed due to **difficulty reporting symptoms and atypical expression of pain*, which may manifest as behavioral changes rather than direct verbal complaints (Victorio, 2014).
Conclusion
The intersection between autism and migraine involves a complex interaction of genetic, neurochemical, and hormonal factors. The predominance in females may be associated with both hormonal mechanisms and structural differences in the pain modulation system. The presence of dysfunctions in the thalamus, somatosensory cortex, cingulate gyrus, and GABAergic interneurons supports the hypothesis that migraine in autistic individuals results from an imbalance in neuronal excitation/inhibition. Given the high prevalence and functional impact of migraine in this population, early detection and targeted therapeutic strategies are essential to improve the quality of life of these individuals.
References (ABNT)
ALSAAD, A. Autism and Migraine: A Narrative Review. Cureus, vol. 16, 2024. Available at: [https://pubmed.ncbi.nlm.nih.gov/39449896/](https://pubmed.ncbi.nlm.nih.gov/39449896/). Accessed on: 08 Feb. 2025.
CANITANO, R.; SCHRÖDER, C. Headache in Autism Spectrum Disorders. In: *Handbook of Clinical Neurology*, 2017, p. 153-161. DOI: [10.1007/978-3-319-54726-8_14](https://doi.org/10.1007/978-3-319-54726-8_14).
SAHITO, A. Migraine and Autism Spectrum Disorder: A Shared Hereditary Basis. Neuropsychiatric Disease and Treatment, vol. 17, p. 1733-1734, 2021. DOI: [10.2147/NDT.S320822](https://pubmed.ncbi.nlm.nih.gov/34123208/).
SULLIVAN, JC et al. The presence of migraines and its association with sensory hyperreactivity and anxiety symptomatology in children with autism spectrum disorder. Autism, vol. 18, no. 6, p. 743-747, 2014. DOI: [10.1177/1362361313489377](https://journals.sagepub.com/doi/10.1177/1362361313489377).
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