The results of a cross-sectional study highlight the clinical features that bipolar disorder and migraines have in common and assess the characteristics of patients with both disorders.
The prevalence of migraines is high in people with bipolar disorder (BD) and, according to the results of a cross-sectional study, is associated with a more severe clinical burden, including increased comorbidity with pain and inflammatory disease. The results were published in the Journal of Affective Disorders.
Both BD and migraines are the leading causes of disability worldwide, while previous studies have shown that more than a third of people with BD experience migraines. “Conversely, patients with migraines have increased rates of BD, and a family history of BD is a risk factor for developing migraines,” the authors write.
The courses of BD and migraines also have similarities, such as recurring episodic presentations, evening chronotypes and eating habits. In addition, cardiometabolic disorders such as obesity and high blood pressure are common in patients with BD and migraines.
To better understand the clinical correlates, patterns of general medical comorbidities, and treatment of patients with BD and migraines, researchers examined the prevalence of migraines in a large sample of patients with BD from the Mayo Clinic Bipolar Disorder Biobank.
All subjects were between 18 and 80 years old, and of the 721 patients with BD identified in the cohort, 207 (29%) reported a lifelong history of migraine themselves. Patients with both BD and migraines were significantly younger and more female than patients with only BD (P <0.01).
- Younger age (odds ratio [OR], 0.98; P <.01), female gender (OR, 2.02; P <.01), greater weight with regard to shape / weight (OR, 1.04; P = .02), greater comorbidities of anxiety disorder (OR, 1.24 ; P <.01), and evening chronotype (OR, 1.65; P =. 03) were associated with migraines
- Every further year of life corresponded to a 2% reduction (OR: 0.98) in the probability of developing migraines; an additional age of 5 years corresponded to a reduction of 10% (OR, 0.90)
- Separate regression models for each general medical comorbidity (controlled by age, gender and location) showed that migraines were significantly associated with fibromyalgia (OR 3.17; P <0.01), psoriasis (OR 2.65; P = 0.03) and Asthma (OR, 2.0; P <0.01)
- For each additional anxiety disorder occurring at the same time, the likelihood of developing migraines increased by 24%
- Participants with migraines were more likely to receive attention deficit / hyperactivity disorder (ADHD) drugs (OR 1.53; P = .05) or compounds associated with weight loss (OR, 1.53; P = .02) compared to those without migraine
In addition, the authors found “no difference in migraine rates between the BD subtypes or an association of migraine with suicidality or comorbid eating or substance use disorders or cardiometabolic disorders (e.g. obesity), as previously reported,” they noted.
The evening chronotype, reported by a third of migraineurs, serves as a proxy marker for a delay in the circadian phase associated with negative health outcomes, suggesting that circadian system function plays a role in BD and in a subset of patients Migraines could play.
The cross-sectional nature of the study precludes causal conclusions, which is a limitation, while characteristics of the migraines were not assessed (frequency, aura, etc.).
“Our results underscore the need to systematically assess migraine headaches and associated comorbidities as part of routine clinical care in all patients diagnosed with BD. Such an approach could improve the early detection and treatment of the migraine BD phenotype, ”the authors concluded.
“The pattern of general medical comorbidity and associated features present in a well-defined subphenotype such as BD and migraine comorbidity can provide insight into their underlying brain-body interaction disorders, their origins, and their course “, they said.
Romo-Nava F, Blom T, Cuellar-Barboza A, et al. Review of bipolar disorder with migraine phenotype: clinical features and comorbidity. J influence disturbance. Published online 23 August 2021. doi: 10.1016 / j.jad.2021.08.026