Study Evaluates Clinical Commonalities, Comorbidity of Bipolar Disorder and Migraine

Prevalence of migraine is high among those with bipolar disorder (BD) and is associated with a more severe clinical burden, including increased comorbidity with pain and inflammatory conditions, according to results of a cross-sectional study. Findings were published in the Journal of Affective Disorders.

Both BD and migraine are leading causes of disability worldwide, while previous studies have revealed migraine occurs in more than one-third of individuals with BD. “Conversely, patients with migraine have elevated rates of BD, and a family history of BD is a risk factor for migraine development,” the authors wrote.

The courses of BD and migraine also share commonalities, such as recurrent episodic presentations, evening chronotypes, and dietary habits. In addition, cardiometabolic conditions like obesity and hypertension are common in those with BD and migraineurs.

To better understand the clinical correlates, patterns of general medical comorbidities, and treatment of patients with BD and migraine, the researchers assessed the prevalence of migraine in a large sample of patients with BD from the Mayo Clinic Bipolar Disorder Biobank.

All individuals were between the ages 18 and 80, and of the 721 patients with BD identified in the cohort, 207 (29%) self-reported a lifetime history of migraine. Patients with both BD and migraine were significantly younger and more likely to be female than those with just BD (P <.01).

Analyses revealed:

• Younger age (odds ratio [OR], 0.98; P <.01), female sex (OR, 2.02; P<.01), higher shape/weight concern (OR, 1.04; P = .02), greater anxiety disorder comorbidities (OR, 1.24; P <.01), and evening chronotype (OR, 1.65; P = .03) were associated with migraine
• Each additional year of age corresponded with a 2% reduction (OR, 0.98) in the odds of having migraine; an additional 5 years of age corresponded with a 10% reduction (OR, 0.90)
• Separate regression models for each general medical comorbidity (controlled for age, sex, and site), showed migraines were significantly associated with fibromyalgia (OR, 3.17; P <.01), psoriasis (OR, 2.65; P = .03), and asthma (OR , 2.0; P <.01)
• For each additional co-occurring anxiety disorder, the odds of having migraine increased by 24%
• Participants with migraine were receiving attention deficit/hyperactivity disorder (ADHD) medication (OR, 1.53; P = .05) or compounds associated with weight loss (OR, 1.53; P = .02) at higher rates compared with those without migraine

In addition, the authors did not “find a difference in migraine rates between BD subtypes, or an association of migraine with suicidality or comorbid eating or substance use disorders, or cardiometabolic disorders (eg, obesity), as previously reported,” they noted.

The evening chronotype reported by one-third of migraineurs serves as a proxy marker of circadian phase delay associated with adverse health outcomes, suggesting circadian system function may play a role in BD and migraine in a subset of patients.

The cross-sectional nature of the study precludes causal conclusions from being drawn, marking a limitation, while characteristics of migraine were not assessed (frequency, aura, etc).

“Our results highlight the need to implement a systematic assessment for migraine headaches and associated comorbidities in all patients diagnosed with BD as part of routine clinical care. Such an approach could enhance early identification and treatment of the migraine-BD phenotype,” the authors concluded.

“The pattern of general medical comorbidity and associated features that are present in a clearly defined sub-phenotype like the BD and migraine comorbidity may provide insight into their underlying brain-body interaction disturbances, their origins, and progression,” they said.

Reference

Romo-Nava F, Blom T, Cuellar-Barboza A, et al. Revisiting the bipolar disorder with migraine phenotype: clinical features and comorbidity. J Affect Disord. Published online August 23, 2021. doi:10.1016/j.jad.2021.08.026