Neurodivergence and access to migraine care

To mark Neurodiversity Celebration Week 2026, the National Migraine Centre’s neurodiversity lead, Dr Lisa Rodolico, shares her thoughts on accessible and inclusive healthcare – and the work we are doing to make that a reality.

Dr Lisa Rodolico

It isn’t unusual to encounter someone who struggles to seek access to medical care. Among medical professionals – especially in rural settings – we often note that if a farmer is phoning for an appointment, something must be seriously wrong, because seeking help is usually a last resort.

We also recognise that certain groups experience greater barriers to accessing healthcare, particularly those who are marginalised or whose differences are not immediately visible.

One such group is the neurodivergent community. Neurodivergence refers to natural variations in cognitive processing – such as autism, ADHD, dyslexia, dyspraxia, and others – that shape how people perceive, communicate, and move through the world.

A neuroaffirmative approach recognises these differences as valid, not deficient, and works to reduce the barriers our systems unintentionally create.

Accessing healthcare can be particularly challenging for neurodivergent people, in part because many individuals – especially women and people assigned female at birth – have historically been misdiagnosed or missed altogether. Many older adults are only now recognising their neurodivergence, often after years of navigating healthcare systems that didn’t fully understand their needs.

When symptoms have been repeatedly explained away, or when mental health labels have been layered without a full understanding of underlying neurodivergence, it is understandable that trust becomes fragile.

This challenge is magnified when the person also lives with migraine – another largely invisible condition that is too often underestimated. When both neurodivergence-related experiences and migraine symptoms have been dismissed or minimised, seeking care again can feel overwhelming.

Communication differences and people-pleasing tendencies common in neurodivergent patients can create additional, often invisible barriers. A patient may downplay the severity of their symptoms, mask their distress, or report adherence to treatment despite struggling in reality. None of this is intentional deception; it is often a well-practised strategy for navigating environments where they fear being judged, misunderstood, or dismissed.

Medication adherence is a frequent challenge too. Anxiety around taking medication, uncertainty about instructions, or a need for very clear, structured guidance can all affect confidence. Executive function differences can make routine-building difficult, and well-meant suggestions like ‘just set an alarm’ may feel invalidating when the person has spent a lifetime trying strategies that haven’t worked. Supportive exploration – focusing on motivation, offering collaborative problem-solving, and using techniques such as habit stacking – can all be far more effective. Neurodivergent patients are often highly resourceful; given space, they usually already know what may work best for them.

Even the process of booking an appointment can be a major hurdle. Multiple steps, unpredictable phone interactions, and rushed reception environments can heighten rejection sensitivity or social anxiety. In primary care, the changing availability of clinicians may make follow-up even more daunting. These challenges can lead people to delay seeking help for months or even years, despite significant symptoms.

In migraine care, we often encourage lifestyle adjustments – sleep routines, diet, exercise, hydration. Neurodivergent patients are usually well aware of these recommendations. The difficulty is not knowledge, but whether those changes are compatible with their needs, sensory profile, or executive functioning capacity. A neuroaffirmative clinical relationship acknowledges this and works with the patient’s strengths, not against their challenges.

At the National Migraine Centre, we aim to create a supportive, predictable environment for neurodivergent patients. Every member of our clinical team receives training in neurodivergence and its impact on healthcare access. We offer longer appointments when needed, use consistent consultation structures, and provide clear written information to support recall. Our administrative team is trained to communicate in a patient-centred, understanding way, and we strive for continuity by keeping patients with the same clinician whenever possible.

We encourage individuals to share their neurodivergence – diagnosed or self-identified – so that we can adapt our approach accordingly. Collaborative decision-making is central: treatments, lifestyle adjustments, and communication strategies are tailored to each person’s needs, values, and sensory or executive-function profile.

By recognising the unique barriers neurodivergent people face, and by adapting the clinical environment rather than expecting patients to mask or stretch themselves to fit it, we hope to improve access to migraine care and ensure that neurodivergent voices are truly heard.