Headaches, Migraines and Bipolar Disorder
I get nasty headaches with bipolar disorder. I don’t think they’re migraines, but I do have to take medication and typically have to lie down for the headaches to go away. They tend to happen about two hours after I get up in the morning (meaning medication side effects may play a part, certainly). And I know that I’m not the only person with bipolar disorder suffering with headaches or even migraines – there is, actually, a known link.
Bipolar Disorder and Headaches
In my case, my headaches may stem from my bipolar medication. Because of when they tend to occur (about two hours after taking the medication), that seems likely. Nevertheless, they do occur at other times, too, which makes me think that I also have bipolar-related headaches.
There don’t seem to be a lot of studies on bipolar disorder and headaches, per se, but there is quite a bit of information on bipolar disorder and migraine headaches.
Migraine Headaches and Bipolar Disorder
It’s been known for some time now (at least a decade) that bipolar disorder is correlated with migraine headaches. There is actually bi-directional link (i.e., if you have migraines you’re more likely to have bipolar and vice versa). I hate to say this kind of stuff about an already impossible disorder but I suppose, when it rains it pours.
In this 2015 meta-analysis (14 studies included), it was found that 34.8% of people with bipolar disorder, also had migraines. And more people with bipolar type II had migraines (54.17% compared with 32.7% for those with bipolar I). It was also found that the greatest prevalence of migraines in the bipolar population was in South America when compared to North America and Europe. (A big jump in South America. Something to do with the greater number of hours in the sun perhaps due to the photosensitivity found in migraine headaches?)
In this 2015 systematic review, 77% of bipolar II women Hs migraines. Also, up to 45% of people with “cyclothymic temperament” also suffered from migraines. This review concludes that bipolar-migraine comorbidity actually comprises a bipolar subtype.
(By the way, annual estimates of migraine prevalence in the general population range from 3.3% to 21.9% for women and from 0.7% to 16.1% for men.)
The Problem with Migraine Headaches in Bipolar Disorder
I know, you’re saying, “Aren’t migraine headaches the problem with migraine headaches in bipolar disorder?” Well, yes, of course, you’re correct. But there are further issues.
For example, this study found that those with bipolar and comorbid migraines had worse treatment outcomes. They had more mood episodes (especially depressions) and a higher prevalence of other psychiatric and medical comorbidities.
Did I mention when it rains it pours?
Treating Bipolar Disorder with Migraine Headaches
Of course, typical migraine headache treatments are used when one has bipolar disorder as well. These include:
- Pain relievers
- Triptans (blood vessel constriction medications; may cause mood fluctuations)
- Ergots (Ergotamine and caffeine combination drugs, possibly less effective than triptans)
- Anti-nausea medications
- Opioid medications
- Glucocorticoids (such as prednisone)
(This, by the way, brings me to another issue: drug seeking. People with mental illness are often seen as drug-seekers thanks to the high prevalence of substance use disorders with bipolar disorder. I suspect this makes it very hard for people with serious migraines to get adequate treatment as, of course, there is no physiological test for migraines as there is no physiological test for bipolar. Nevertheless, people with bipolar disorder deserve quality care, just like everyone else. It should not be assumed we are drug-seeking.)
In addition to the above, some studies have been done on bipolar disorder and migraines:
- This study posits that treating inflammation will treat both the bipolar and the migraines.
- This case report says adjunctive topiramate (Topamax) was helpful.
- The above case report also says that adjunctive antidepressants may be helpful but, obviously, this carries risk for those with bipolar disorder.
There was also one study I found that linked positive headache treatment to bipolar disorder (good news):
Patients with reduction in headache frequency after treatment had lower scores on the . . . Major depression and Avoidant personality pattern scales and higher scores on the Alcohol Dependence, Self-Defeating personality pattern, Depressive personality pattern, Drug Dependence, Aggressive personality pattern and Bipolar. . .
In Short: Migraines and Bipolar
In short, if you have bipolar disorder and migraine headaches you are not alone. My suggestion would be not to let your bipolar disorder get in the way of proper migraine treatment; because, as the studies like to say, migraines pose “a significant burden” on the sufferer. We deserve the same quality of treatment as anyone else. Demand it.
Banner image by Flickr user Mislav Marohnić.
Inset image by Flickr user r. nial bradshaw.
About Natasha Tracy
Natasha Tracy is an award-winning writer, speaker and consultant from the Pacific Northwest. She has been living with bipolar disorder for 18 years and has written more than 1000 articles on the subject.