Comorbid Bipolar Disorder and Migraine: From Mechanisms to Treatment

Abstract

Bipolar disorder (BD) is a severe psychiatric disorder characterized by recurrent episodes of manic/hypomanic or depressive symptoms and euthymic periods, with some patients suffering a gradual deterioration of illness and consequent cognitive deficits during the late stage. Migraine is a disease generally without abnormal medical examinations, neurological examinations or laboratory studies, and the diagnosis is made based on the retrospective demonstration of headache features and groupings of disease-associated symptoms. The epidemiology of comorbid BD and migraine is high and it is obligatory to find effective treatments to improve the prognosis. Recent investigations demonstrated that the close relationship between BD and migraine significantly increased the rapid cycling rates of both BD and migraine in patients. Although the detailed mechanism is complex and largely unclear in comorbid BD and migrain, genetic factors, neurotransmitters, altered signaling pathways, disturbances of inflammatory cytokines, and mitochondrial dysfunction are risk factors of BD and migraine. Particularly these two diseases share some overlapping mechanisms according to previous studies. To this end, we call for further investigations of the potential mechanisms, and more efforts are underway to improve the treatment of people with comorbid BD and migraine. In this review, we provide an overview of the potential mechanisms in patients with BD or migraine and we further discuss the treatment strategies for comorbid BD and migraine and it is obligatory to find effective treatments to improve the prognosis. This work will provide insights for us to know more about the mechanisms of comorbid BD and migraine, provides new therapeutic targets for the treatment and give clinicians some guidance for more appropriate and beneficial treatment.

Global trends and hotspots in pain associated with bipolar disorder in the last 20 years: a bibliometric analysis

“…The comorbidity of migraines and bipolar disorder might be due to dysfunctions in neurotransmitters within the shared serotonergic, dopaminergic, and glutamatergic pathways of the two conditions. Additionally, some studies indicate the presence of common genetic abnormalities between migraines and bipolar disorder ( 39 ).…”

Risk of major mental disorders in the offspring of parents with migraine

“…In addition, serotonin receptors, serotonin transporters, and catecholamines have also been implicated in migraine and various mental disorders [ 18 , 19 ]. Considering the complicated etiologies and poor prognosis of patients with migraine and mental illness [ 20 , 21 ], clinicians should be aware about this comorbidity.…”

Migraine in bipolar disorder and schizophrenia: The hidden pain

“…Moreover, a common pharmacological therapy for managing both conditions with valproate suggests shared neurobiological mechanisms. 7…”

“…Moreover, a common pharmacological therapy for managing both conditions with valproate suggests shared neurobiological mechanisms. 7 However, the link between schizophrenia and migraine is less definitive. 5 Although glutamatergic and dopaminergic neurotransmission is implicated in the underlying pathophysiology of both disorders, few studies have addressed migraine comorbidity in patients with schizophrenia.…”