Migraine and Bipolar Disorder: What’s the Link?

Are migraine episodes associated with bipolar disorder? 

Bipolar disorder (BD) and migraine frequently co-occur. This connection is particularly strong in people who experience migraine episodes with aura (visual or sensory disturbances before the headache) or those with chronic migraine (headaches occurring on 15 or more days per month).

Studies suggest that approximately 24.5% to 24.8% of individuals with BD experience migraine, compared to 10.3% in the general population. In many cases, migraine precedes the onset of BD.

There’s a genetic component between the disorders, and a family history of BD is a strong risk factor for migraine. Migraine is more commonly reported in BD II (at least one hypomanic episode, but not full mania) than in BD I (at least one manic or mixed episode).

When BD is comorbid with migraine episodes, the course of BD tends to be more severe. This can lead to more intense or frequent mood swings, making symptom management more challenging.

Common causes linking bipolar and migraine to rapid cycling

There’s evidence to suggest that having both BD and migraine can lead to more frequent mood episodes in BD (rapid cycling) and more frequent migraine attacks.

This may be due to the following shared underlying mechanisms:

• Genetic factors: Studies have found specific genetic variations that increase the risk of developing both conditions. These genetic factors can make mood swings in BD more frequent or lead to more migraine attacks.
• Neurotransmitters: Imbalances in neurotransmitters like serotonin, dopamine, and norepinephrine are involved in both BD and migraine. These imbalances can lead to rapid cycling and the co-occurrence of BD and migraine.
• Altered signaling pathways: Changes in brain signaling pathways related to mood regulation and pain processing may contribute to the development of both disorders and rapid cycling rates.
• Inflammatory cytokines: Inflammatory cytokines, which are involved in the body’s immune response, may be elevated in individuals with BD and migraine.
• Mitochondrial dysfunction: Mitochondria produce energy in cells. Dysfunction in mitochondrial function is linked to both BD and migraine, possibly contributing to higher rates of rapid cycling and the co-occurrence of BD and migraine.

What migraine symptoms are common with bipolar disorder? 

There are several overlapping symptoms between BD and migraine, including the following:

• Mood changes: Both conditions can involve significant mood swings. For instance, the prodrome or postdrome phases of a migraine can include irritability, depression, or euphoria, which can resemble mood episodes in BD.
• Sleep disturbances: Both BD and migraine can disrupt normal sleep patterns. Insomnia or excessive sleeping can occur in both conditions.
• Fatigue: Chronic fatigue is common in both migraine and BD, particularly during depressive episodes or after a migraine attack.
• Cognitive impairment: Both conditions can cause difficulties with concentration, memory, and overall cognitive function, known as “brain fog.” Research shows that the ability to think and positive mood decline starts 25 to 36 hours before a migraine and worsens in the last 12 hours.
• Sensory sensitivity: Increased sensitivity to light, sound, and sometimes touch can be seen in both migraine and during manic or depressive episodes in bipolar disorder.
• Anxiety and depression: High levels of anxiety and periods of depression are common in both BD and migraine sufferers.
• Sensitive to stress: Stress is a well-known trigger for migraine attacks and can also exacerbate mood swings and other symptoms in individuals with bipolar disorder.

Treating bipolar disorder and migraine together 

• Medication management: Some medications used to treat bipolar disorder, such as mood stabilizers (e.g., lithium, valproate) and certain anticonvulsants (e.g., topiramate), can also help prevent migraine symptoms.
• Therapy: Psychotherapy, such as cognitive behavioral therapy (CBT), can help manage bipolar symptoms and provide coping strategies for migraine episodes.
• Medications for migraine: Acute migraine medications, such as triptans (e.g., sumatriptan, rizatriptan), nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen, and muscle relaxants can be used to relieve severe migraine symptoms.
• Alternative therapies: Acupuncture and certain nutritional supplements (e.g., magnesium, riboflavin, coenzyme Q10) may help reduce migraine frequency and severity.
• Lifestyle modifications: Maintaining a regular sleep schedule, managing stress, engaging in regular exercise, and eating a healthy diet can benefit both conditions.

It’s important to avoid mixing some migraine medications, like triptans and ergotamines, with bipolar disorder medications, as this can lead to harmful interactions such as serotonin syndrome and vasoconstriction.

Make sure that your primary healthcare professional is aware of all your physical and mental health conditions when prescribing medications.

Takeaway

Migraine and bipolar disorder have a complex relationship, with studies suggesting a higher prevalence of migraine headaches in individuals with bipolar disorder. Shared genetic and neurobiological factors, as well as common triggers like stress, may contribute to this link.

To manage both conditions, it’s important to work closely with healthcare providers to develop a comprehensive treatment plan. This may include medications, lifestyle modifications, and therapy to address the emotional and psychological aspects.