Parental and comorbid migraine in individuals with bipolar disorder: A nationwide register study

Abstract

Background Genetic studies imply a shared genetic etiology between bipolar disorder (BD) and migraine. Epidemiological studies have demonstrated elevated comorbidity between these disorders, but haven’t controlled for parental psychopathology. No previous nationally representative studies exist on familial clustering of BD and migraine. This study examines the association between parental and comorbid migraine and BD, controlling for potential confounders. Methods We identified 1861 cases aged ≤25 years, 3643 matched controls, and their parents from Finnish national registers. Conditional logistic regression was used to calculate odds ratios (ORs) with 95% confidence intervals (CIs) and two-sided significance limits of p<0.05. Results Parental migraine, controlling for parental BD, was associated with offspring BD diagnosed at age ≥18 years (OR 1.52, 95%CI: 1.08–2.14). Associations between BD and comorbid migraine persisted following adjustment for parental BD and parental migraine in all subjects (OR=2.46, 95% CI: 1.76–3.42), both age groups of BD-diagnosis (<18 years, ≥18 years) and both sexes. Limitations The diagnoses were register-based, not directly ascertained. Conclusions This study indicates that parental migraine, even in the absence of parental BD, is a risk factor for offspring BD. Thus, a genetic link between BD and migraine could potentially explain some of the elevated comorbidity between these disorders. However, BD shows a stronger association with comorbid migraine than with parental migraine, suggesting that much of the elevated comorbidity is related to non-genetic factors. Increased understanding of mechanisms underlying the comorbidity of BD and migraine is important since it is associated with poorer health-related outcomes compared with BD alone.

Screening for bipolar disorder among migraineurs: the impact of migraine&ndash;bipolar disorder comorbidity on disease characteristics

“…Besides, MIDAS scores >30 were associated with 3.69 times increased likelihood of having BD in migraineurs. Accordingly, our findings seem to emphasize the potential of screening for comorbid BD among migraineurs, particularly in those with disability and poor functionality, to implement adequate treatment strategy and limit potential adverse outcome 12,33,48. Notably, an increase in MIDAS scores and a significant deterioration in the functionality were also reported in a recent study among Turkish migraineurs, in case of comorbid personality disorders 48…”

“…A family history of mood disorder and migraine in first-degree relatives was also reported to be associated with an increased risk of comorbidity 32. Besides, parental migraine is suggested to be an independent risk factor for BD in the offspring, even in the absence of parental BD 33. Given the association of a family history of type I BD with 14.42 times higher likelihood of having BD in a patients with migraine, our findings emphasize that a positive family history of BD may refer to a stronger risk factor for BD development in the presence of migraine.…”

Clinical characteristics of patients with bipolar disorder and premorbid traumatic brain injury: a cross-sectional study

“…Inflammation and impaired pain modulation after TBI are two of the suggested pathophysiological mechanisms (Ruff et al 2016 ). Furthermore, migraine and BD are bi-directionally associated (Fornaro et al 2015 ) and possibly influenced by shared environmental and genetic factors (Sucksdorff et al 2016 ). It is thus difficult to conclude on the nature behind our finding of an association between migraine and premorbid TBI among patients with BD.…”

Comorbid Bipolar Disorder and Migraine: From Mechanisms to Treatment

“…Parental migraine has been demonstrated to serve as a risk factor for offspring BD, even in patients without parental BD, and there seems to be a common genetic factor between BD and migraine. However, BD is more closely related to comorbid migraine than parental migraine, and this elevated comorbidity may be attributed to nongenetic factors ( 60 ). Both of BD and migraine are closely associated with abnormalities in serotonergic pathways, dopaminergic pathways, and glutaminergic systems.…”