Migraine a depressing issue in bipolar disorder

By Eleanor McDermid, Senior medwireNews Reporter

Patients with bipolar disorder have a markedly increased prevalence of migraine, report researchers.

They also found that the presence of migraine was associated with poorer outcomes, particularly resulting in more frequent and severe depression.

Based on their findings, the researchers, led by Erika Saunders (Penn State College of Medicine, Hershey, Pennsylvania, USA), advise clinicians to be alert for migraines in all women with bipolar disorder and in men with bipolar II disorder.

“Effective treatment of migraine may impact mood outcome in bipolar disorder as well as headache outcome”, they suggest.

Migraine was present in 31% of 412 bipolar disorder patients from the Prechter Longitudinal Study of Bipolar Disorder 2005–2010, compared with just 6% of 157 healthy controls with no personal or family history of mood disorders. This equated to a sixfold increased risk for migraine among bipolar disorder patients after accounting for age, gender and body mass index.

In both groups, individuals with migraine were predominantly women (90% in the control group, 83% in the bipolar group). Indeed, among bipolar disorder patients, being female raised the likelihood of having migraine threefold after accounting for confounders.

Among men, migraine was 9.9-fold more likely to occur in bipolar II disorder than bipolar I disorder, but this association did not occur among women. Also, having mixed symptoms increased the likelihood of migraine 3.5-fold among men but had no effect in women.

During up to 5 years of follow-up, depression was significantly more severe among patients with migraine, at an average of 18.3 points on the Patient Health Questionnaire (PHQ)-9, compared with 14.4 points among those without migraine. Depression was also more frequent among patients with migraine, who spent a significantly higher proportion of follow-up depressed relative to those without migraine.

The associations between migraine and depression remained significant after accounting for confounders, whereas there were no significant associations with the severity or frequency of mania.

“Further study into the common mechanism underlying migraine headache and bipolar disorder, as well as effects of treatments on conditions, may lead to improved outcomes for people with bipolar disorder and migraine comorbidity,” concludes the team.

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