A new study in Brain and Behavior has unraveled the relationship between migraines, bipolar disorder, and patient outcomes. Nicole Sekula and colleagues conducted an 11-year longitudinal study demonstrating that those with bipolar disorder and migraines experienced worse symptoms of depression, mania, and a diminished quality of life on average. In addition, if those individuals were also prescribed lithium, their symptoms of mania were worse than those with migraines not taking lithium.
Approximately 30% of people with bipolar disorder also suffer from migraines, compared to around 17% of the general population. Prior research has found that those with migraines and bipolar disorder are more vulnerable to severe depression, suicidal ideation, and anxiety disorders. In addition, researchers have found that those with bipolar disorder and migraines relapse more frequently if they take lithium for their bipolar diagnosis.
Sekula and colleagues felt additional research was necessary to understand how this finding may impact patients. If lithium is found to increase symptoms in people with bipolar disorder and migraines, it will require changes in treatment protocols for those who fit the criteria.
The research team recruited 538 individuals diagnosed with bipolar I. Thirty-one percent of the participant group suffered from migraines; the remainder did not. From 2005-2016 these participants filled out health questionnaires every two months and measures of mania and depression yearly. The participants were divided into four comparison groups: those with migraines taking lithium, those without migraines taking lithium, those with migraines not on lithium, and those without migraine taking lithium. These four groups were then compared using the data collected on depression, mania, and quality of life.
This process revealed that those with migraine experience more depression, more mania, and lower quality of life scores than those without migraine. This was true regardless of lithium use or not. Over 11 years, when subjects who suffered from migraines were prescribed lithium, symptoms of mania were significantly worse than all other groups in the study.
The research team identifies a few limitations to consider. First, the data was collected through self-report for migraine history and lithium use. Medical records were not used to verify participant claims. Research found self-report methods for chronic conditions to be reliable, but medical records would have ensured the data was not skewed.
Second, blood tests to determine the amount of 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 individuals began experiencing migraines and when they began to take lithium was unknown. These dates might have been helpful in understanding if the timing of migraine onset was pertinent to lithium use or poor outcomes.
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, along with published observations, suggest that lithium is in fact 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 disorder I and migraine“, was authored by Nicole Sekula, Anastasia Yocum, Steven Anderau, Melvin McInnis, and David Marshall.