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 have 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.
It’s also worth noting that here, they found that those with bipolar disorder and migraine headaches were more likely to rapid-cycle and have panic attacks.
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.
I tried Topiramate , at first 2 weeks no headaches but after everything went back the way it was before i started it so i gave it up.
This is so strange… prior to my bipolar diagnosis I was plagued by terrible migraines. Often in coordination with depreesive episodes (at the time my depression manifested as severe pain like a really bad full).
After I began treatment, the migraines went away. I haven’t had but 1 migraine in the last 10 years. After reading this article I realized I’ve been on topirimate the entire time. I wasn’t put on it for migraines but now I know might have been the key to helping with what had been a major issue for a long time.
Thank you as always for your insightful article. Once again I have learned another nugget about myself and my treatment.
Simple, your body is not a chemical factory. Give it a break.
can’t resist criticizing the pic of the sleeping woman at head of tis post — my goodness, what atrophied arms! my two rower daughters might not be as photogenic, but they could twirl that model like a baton.
We are human. Humans experience pain. It is not uncommon to have a headache. Migraines are not ordinary headaches, granted. I have them on occasion and they are hormone related, not Bipolar related.
This is what I have experienced: Medical Practitioners, as a whole, dismiss many things especially if they are aware of severe mental illness.
I have a “abnormal” MRI and symptoms of seizures. So, I was diagnosed with Seizures… that is; until the Neurologists found out I have a psychiatric illness, or 2.
The list of medications that I’ve taken for well over 30 years are anti-depressants, benzodiazepines, anti-epileptic (commonalty known as “mood stabilizers” in the psych world) and anti-psychotics. In having a somewhat lengthy list of these medications… all of which are also used for Migraines and Seizures… I am dismissed as “we just don’t know what your spells are, maybe .they are mood related.” from Neurologists.
So.. because the Neuros I’ve seen over the last 9 years dismiss my seizures, that they’ve each diagnosed until they get the psych history and med list…. I am not “seen” by a neurologist and my primary care refuses (he is not a specialist, he says).
So, I suffer with seizures that are not controlled nor treated. I have to go to a psychiatrist to convince to prescribe me an anti-epileptic/mood-stabilizer in the hopes that it or they will do double duty in treating both. The psychs prescribe, saying “well, maybe they’ll help with your spells as well as your mood swings.”
Does this mean my seizures are Bipolar generated? No. I had a car accident and suffered a closed-head injury.
My migraines… are hormonal related. I take over-the-counter meds and lay down in a darkened cool bedroom for a day or so.
Again… went to a Neurologist for migraines years back… again, they found my psych history.
I hate that I am dismissed for medical issues because I’m mental.
That’s very interesting. I get ocular migraines, where I see colored lights (to the point of not being able to see anything else; like not being able to drive, read, use the computer, etc.) but don’t have any actual head pain. They go away after half an hour or so, but they’re pretty disturbing when they come around. I wrote a blog post about them, and three different family members contacted me to say the same thing happened to them. So there must be a genetic component that runs along the genetic tendency to be bipolar in the 1st place.
I had 6 x ECT treatments over a two week period in November of last year. I do suffer from migraines, am on Topomax which most definately helps but am finding a most odd sensation which I am wondering if anybody can comment on ,thinking may be a side effect from the ECT….. It feels more like major pressure at the back and over the top of my head along with vertigo and my brain literally seems to slow down to the point where I find it hard to do simple maths and decision making. The closest thing I can find on dr Google is MAV – MIGRAINE ASSOCIATED VERTIGO.
Natalie, I suffered from two types of chronic (common and cluster) migraines for years, and the only medication that worked on them was an ergotamine injection. They were debilitating. Now, one of the medications I take for bipolar 2 is also a med that works to prevent migraines (topamax). I never connected the two before. I still get an occasiona, but mild, migraine but nothing like I used to.
Thank you again for continuing to inform those of us with bipolar. Making more sense every day.
there’s a wonderful article in a r-ecent “new yorker” re the treatment of headaches — http://www.newyorker.com/magazine/2017/01/23/the-heroism-of-incremental-care — that covers the maddening difficulty of treatment. in my own life, when i was younger, headaches were at times debilitating, but they tended to go away as mysteriously as they arrived. as for meds, i am religiously averse to adding anything new to the lithium + maoi combination that has worked for me since 1980. it’s hard enough to balance just these two. when i had cancer c y2k (stage iv colon) it was very difficult staying sane with the barrage of new drugs that chemo etc required.
I have bipolar type 1 and have had periods of time where I suffered from migraines. It’s funny, though, I don’t think I ever had migraines until I was about 38 years old, but I’m pretty sure I had bipolar disorder as far back as 15 years old. Actually, the migraines started soon after the 4 worst years of my bipolar disorder. Those were years when all kinds of crazy stuff was happening to me (depersonalization/derealization, agoraphobia that I had never had before, specific phobias). My migraines were painful, but the worst part was the nausea and vomiting. When I’d get the migraines I’d pretty much be hovering over the toilet for most of the day.
My migraines were bad, but not chronic. I started out getting them about one every other month. At the worst I had three in a month. So i guess I shouldn’t feel THAT sorry for myself. Also, I ended up going to a neurologist for something else, and she gave me sumatriptan for the migraines. For me, sumatriptan works wonderfuls. Literally minutes after I’d feel the nausea starting I’d give myself the sumatriptan injection. Then within moments a very funky, but cook sensation comes over me. And then the migraine and the nausea are gone. I guess I’m lucky. I’m also lucky that after about three years of having migraines off and on they suddenly disappeared [I’m currently knocking on wood.] I haven’t had a migraine headache for at least two years now.
I do get headaches occasionally, but I am 99% sure most are related to my sinusitis. I know because they are different kinds of headaches. More sinus pressure headache. The bad thing about those, though, is that nothing seems to relieve them that is the usual OTC or what an Ear Nose & Throat doctor prescribed. The only thing that helps is pseudophedrine (a stimulant), which my pdoc says NOOOOOO! to me taking. He’s right to say no, because I have in the past slightly abused it short-term. Sometimes with my bipolar I go through periods of extreme fatigue and lethargy. The stimulant seems to help. But I know if I abused it regularly I’d be up the creek. I have a history of pdoc’s giving me a stimulant (like Provigil & Ritalin) and then very soon after becoming full-blown manic and half-way through the door to the psych hospital.
Curious fact…
Though I was finally getting past some of that crazy stuff I mentioned above (dissociation, agoraphobia, etc.), and finally past the headache type migraines, I was having some other strange experiences out of the blue. For a period of about 6 months sometimes I would be outside or driving in the sun and a sudden panic would come over me. I’d start to have visual and auditory distortions. All I’d want to do is to get back home (or to a hotel room in one case) and close all the blinds/curtains and sit in the dark for an hour. Then it would pass. I described this to my pdoc and he told me he thought I was having silent migraine auras. Hmm? I had to look that one up. But it seemed to fit. So I do try hard to avoid the triggers. I’ve managed to be silent migraine aura free for at least 9 months now.
I don’t think any of my bipolar medication ever gave me migraines. In fact, I take a rather hefty dose of carbamazepine (Tegretol XR) and I’ve read that Tegretol is actually helpful at preventing migraines. Well, it didn’t for that period I mentioned above, but who knows, maybe my migraine headache experiences could have been worse without it.
I know there must be a connection. Bipolar has been rampant throughout my family. My depressive paternal grandmother had frequent headaches. My bipolar father did. My bipolar nephew had migraines, which is pretty unusual for a boy. I have a daughter who is treated for depression. She has really bad headaches and some panic attacks. She is still under 40 and I hope and pray that bipolar never occurs. She is a wonderful person and it would be heartbreaking for this to mar her life.
Great post. Totally accurate! It’s actually not only bipolar disorder that has a strong bidirectional connection with migraines, but mental illness more generally. I’d say at least 3/4 of the patients my wife sees (general psychiatry, though many patients with chronic physical illness which may skew the numbers up a bit) suffer from severe headaches, half of those with chronic migraines. She also gets bad migraines herself.
One note… the treatment with the best evidence for migraine prophylaxis is Botox. There are some other things used, including some psychotropics like nortriptyline and anticonvulsants like topiramate, as well as supplements like riboflavin, which have varying degrees of weaker evidence for prophylaxis. I think you hit all the big ones as far as the abortives that you mentioned.
I’m thankful not to suffer from migraines, but if you do get them especially frequently, push as hard as you can for a referral to a neurologist who specializes in headaches. It can be a long period of trial and error to get this sorted out so it pays to be working with someone who really knows what they are doing. Used to live in Calgary (horrible place for migraines because of the chinooks) and Edmonton (better, but still not great) so unfortunately between my wife, her patients, and too many friends and family… this is something I wish I did not know nearly as much about.