Prevalence, Clinical Correlates, and Treatment of Migraine in Bipolar Disorder

Authors

  • Nancy C. P. Low MD,

    1. From the Mood and Anxiety Disorders Program, Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Department of Health and Human Services, Bethesda, Md (Dr. Low); the Centre for Clinical Epidemiology and Community Studies, Sir Mortimer B. Davis Jewish General Hospital (Dr. Galbaud du Fort) and the Department of Psychiatry, McGill University (Drs. Galbaud du Fort and Cervantes), Montreal, Quebec, Canada.
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  • Guillaume Galbaud Du Fort MD, PhD,

    1. From the Mood and Anxiety Disorders Program, Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Department of Health and Human Services, Bethesda, Md (Dr. Low); the Centre for Clinical Epidemiology and Community Studies, Sir Mortimer B. Davis Jewish General Hospital (Dr. Galbaud du Fort) and the Department of Psychiatry, McGill University (Drs. Galbaud du Fort and Cervantes), Montreal, Quebec, Canada.
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  • Pablo Cervantes MD

    1. From the Mood and Anxiety Disorders Program, Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Department of Health and Human Services, Bethesda, Md (Dr. Low); the Centre for Clinical Epidemiology and Community Studies, Sir Mortimer B. Davis Jewish General Hospital (Dr. Galbaud du Fort) and the Department of Psychiatry, McGill University (Drs. Galbaud du Fort and Cervantes), Montreal, Quebec, Canada.
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Address all correspondence to Dr. Nancy Low, Mood and Anxiety Disorders Program, National Institute of Mental Health, Building 15K, Room 208 (MSC 2670), 15 K North Drive, Bethesda, MD 20892-2670.

Abstract

Objective.—To investigate the prevalence, clinical correlates, and treatment of migraine in bipolar disorder.

Background.—The relationship between migraine and mood disorders has been of long-standing interest to researchers and clinicians. Although a strong association has been demonstrated consistently for migraine and major depression, there has been less systematic research on the links between migraine and bipolar disorder.

Methods.—A migraine questionnaire (based on International Headache Society criteria) was administered to 108 outpatients with bipolar disorder. Information on the clinical course of bipolar illness was also collected.

Results.—The overall lifetime prevalence of migraine was 39.8% (43.8% among women and 31.4% among men). In the subgroup of patients with bipolar II disorder, the lifetime prevalence of migraine was 64.7%. The bipolar with migraine group was younger, tended to be more educated, was more likely to be employed or studying, and had fewer psychiatric hospitalizations. Their initial presentation for psychiatric treatment was more often for symptoms of depression, rather than hypomania or mania. They were more likely to have a family history of migraine and psychiatric disorders, and a greater number of affected relatives. They were less likely to use mood stabilizers, and more likely to use atypical antidepressants. Migraine was assessed by a neurologist in only 16% of affected patients. The prevalence of the use of specific antimigraine medications (triptans) was 27.9%.

Conclusions.—This study confirms the higher prevalence of migraine among those with bipolar disorder compared to the general population. Migraine in patients with bipolar disorder is underdiagnosed and undertreated. Bipolar disorder with migraine is associated with differences in the clinical course of bipolar disorder, and may represent a subtype of bipolar disorder.

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