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31 May 2006
Comorbid migraine appears to be frequent in patients with bipolar disorder and associated with greater dysfunction and medical service use, particularly among men, investigators have found.
Roger McIntyre, from the University of Toronto in Ontario, Canada, and colleagues say the findings indicate a possible need for opportunistic screening for bipolar disorder and comorbid migraine.
The team explored the prevalence of comorbid migraine and its implications among 36,984 respondents of the Canadian Community Health Survey for Mental Health and Wellbeing.
Sociodemographic factors, course of illness, and medical service use were compared between individuals meeting the criteria for manic episode and with physician-diagnosed migraine with patients with manic episode but without migraines.
An estimated 2.4% of the participants met the criteria for bipolar disorder. Among these individuals, there was a 24.8% prevalence of migraine, which was significantly higher than the 10.3% for the general population.
The specific prevalence of migraine in men and women with bipolar disorder was 14.9% and 34.7%, respectively, compared with corresponding rates of 5.8% and 14.7% for the general population.
The association between migraine and bipolar disorder remained true even after taking into account age, gender, and other sociodemographic factors, chronic medical conditions, history of major depressive episode, and psychotropic drug use.
The researchers note in the journal Headache that migraine comorbidity appeared to have more serious implications for men with bipolar disorder than for women. Men with both bipolar disorder and migraines had a more severe illness course and more harmful dysfunction as demonstrated by earlier age of onset, more anxiety comorbidity, greater use of multiple medications, disability, and welfare payment than men with bipolar disorder alone.
Among women with bipolar disorder, there was no difference in these factors between those with and without migraines.
"Migraine is more prevalent among persons with bipolar disorder than in the general population," McIntyre and team write.
They suggest that the bipolar disorder and migraine phenotype may comprise a subphenotype of bipolar disorder.
"We feel that there is enough evidence to warrant opportunistic screening and surveillance for the co-occurrence of bipolar disorder and migraine," the researchers conclude.
Source: Headache 2006; 46: 973–982
©2006 Current Medicine Group Ltd
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