Screening for bipolar disorder among migraineurs: the impact of migraine–bipolar disorder comorbidity on disease characteristics

Abstract

PurposeThe aim of this study was to evaluate the prevalence of comorbid bipolar disorder (BD) among migraineurs and the impact of migraine–BD comorbidity on disease characteristics.Patients and methodsA total of 120 adult patients diagnosed with migraine at a single tertiary care center were included in this cross-sectional study. Data on sociodemographic and migraine-related characteristics, family history of psychiatric diseases, comorbid psychiatric diseases, and first-episode characteristics were recorded. Mood Disorders Diagnosis and Patient Registration Form (SCIP-TURK), Mood Disorder Questionnaire (MDQ), and Hypomania Checklist-32-Revised (HCL-32-R) were applied to all patients by experienced clinicians, and clinical diagnoses were confirmed using Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I). Migraine Disability Assessment Scale (MIDAS) was used to evaluate the headache-related disability. Study parameters were compared between migraineurs with and without comorbid BD.ResultsThe diagnosis of comorbid BD was confirmed in 19.2% of migraineurs. A significantly higher percentage of patients with comorbid BD than those without comorbid BD had family history of BD (39.1% vs 6.2%, P<0.001), suicide attempt (30.4% vs 5.2%, P<0.001), and physical abuse (52.2% vs 26.8%, P=0.019). MIDAS scores were significantly higher (50.6 [43.2] vs 33.8 [42.7], P=0.0422) in migraineurs with comorbid BD than in those without comorbid BD. Multivariate logistic regression model revealed that a positive family history of type I BD (odds ratio [OR], 14.42; 95% confidence interval [CI], 2.94–70.73; P=0.001) and MIDAS scores >30 (OR, 3.69; 95% CI, 1.12–12.19; P=0.032) were associated with 14.42 times and 3.69 times increased likelihood of BD, respectively.ConclusionOur findings revealed comorbid BD in a remarkable percentage of migraineurs and a higher likelihood of having BD in case of a positive family history of type I BD and MIDAS scores >30. Comorbid BD was associated with a higher rate for a family history of BD, suicide attempt, and childhood physical abuse as well as aggravated migraine-related disability among migraineurs. Migraineurs with and without comorbid BD showed similar sociodemographic and migraine disease characteristics as well as similar high rates for comorbid anxiety and first-episode depression.

Clinical Correlates of False Positive Assignment in Bipolar Screening Measures Across Psychiatric Diagnoses among Patients without Bipolar Disorder

“…Previous studies argued that hidden or undiagnosed bipolar disorders are substantial among nonbipolar illnesses based on positive assignments from the questionnaires. [24][25][26] But, as observed from our study findings, a con- The FPAs observed in our study could be associated with subthreshold hypomania that only partially meets the DSM criteria. But in a prior study that compared HCL-32 scores and clinically significant subthreshold hypomanic symptoms that partially meet DSM criteria, the HCL-32 was not strongly correlated with subthreshold hypomanic symptoms.…”

Gender Differences and Comorbidities in U.S. Adults with Bipolar Disorder

“…Migraines also had a remarkable association in females with bipolar disease in our study; they were three times more likely to have migraines as a comorbidity than males. There exists a higher percentage of the co-occurrence of migraines and bipolar disorders, predominantly in subjects with a confirmed family history of bipolar disorder, suicidal attempts and childhood physical abuse [ 19 ]. In addition to the higher prevalence ranging from 30 to 34.8% [ 20 , 21 ], patients with bipolar disorders and migraines were also found to have a complex course of the disease with more severe and an increased number of depressive episodes, as well as suicidality [ 22 ].…”

Understanding the nature of psychiatric comorbidity in migraine: a systematic review focused on interactions and treatment implications

“…The relation between stress and migraine is bidirectional and may be direct or indirect. Patients with migraine report higher stress levels when compared to healthy controls (e.g., [109]), and stressors are usually reported as migraine triggers [84, 110–115]. Conversely, migraine itself acts as a stressor resulting in a vicious circle with a strong impact on important individual domains such as work and social functioning [116].…”

“…PTSD is related to the development of pain disorders [119], with a higher prevalence in patients with migraine, and mostly CM, compared to healthy controls [120]. Notably, the available studies found a higher incidence of childhood abuse in migraine patients with BD or depression as compared to those with migraine only [110, 121]. There is also evidence suggesting that PTSD, but not the mere exposure to a traumatic event, is correlated with migraine [122], while in the absence of definite PTSD, only repetitive (≥3) traumatic events enhance the risk for migraine [123–126].…”