A new study in Brain and Behavior has revealed the relationship between migraines, bipolar disorder and patient outcomes. Nicole Sekula and colleagues conducted an 11-year longitudinal study that demonstrated that those with bipolar disorder and migraines experienced worse symptoms of depression, mania, and reduced quality of life on average. In addition, if these people were also prescribed lithium, their mania symptoms were worse than those with migraines who did not take lithium.
About 30% of people with bipolar disorder also suffer from migraines, compared to about 17% of the general population. Previous research has found that those with migraines and bipolar disorder are more vulnerable to major depression, suicidal ideation and anxiety disorders. In addition, researchers have found that those with bipolar disorder and migraines relapse more often if they receive lithium for their bipolar diagnosis.
Sekula and colleagues felt that additional research is needed to understand how this finding might affect patients. If lithium is found to increase symptoms in people with bipolar disorder and migraines, changes in treatment protocols will be required for those who meet the criteria.
The research team recruited 538 people diagnosed with bipolar I. 31 percent of the participating group suffered from migraines. the rest no. From 2005-2016 these participants completed health questionnaires every two months and measures of mania and depression annually. Participants were divided into four comparison groups: those with migraines taking lithium, those without migraines taking lithium, those with migraines not taking lithium, and those without migraines taking lithium. These four groups were then compared using data collected on depression, mania and quality of life.
This process revealed that migraine sufferers experience more depression, more anger and lower quality of life scores than those without migraine. This was true regardless of whether lithium was used or not. Over 11 years, when migraine sufferers were given lithium, mania symptoms were significantly worse than all other study groups.
The research team identifies some limitations that should be taken into account. Initially, data were collected through self-report of migraine history and lithium use. Medical records were not used to verify participant claims. The research found that self-report methods for chronic conditions are reliable, but medical records would have ensured that the data were not skewed.
Second, blood tests to determine how much lithium a person has taken could have been valuable information. If blood tests revealed that participants were not taking their medication consistently, their data should not be included. Third, when the subjects started experiencing migraines and when they started taking lithium was unknown. These dates may have been useful in understanding whether the timing of migraine onset was related to lithium use or poor outcome.
Undeterred by these limitations, Sekula and colleagues recommend that lithium no longer be prescribed for those bipolar I patients who experience migraines. They state, “Our findings, together with published observations, suggest that lithium is actually contraindicated in comorbid bipolar disorder/migraine and other mood-stabilizing medications should be considered.”
The study, “Lithium Use Associated with Symptom Severity in Comorbid Bipolar I Disorder and Migraine,” was authored by Nicole Sekula, Anastasia Yocum, Steven Anderau, Melvin McInnis and David Marshall.