Migraines are awful. There’s no way around it. Debilitating, pulsating pain. Light and sound are like torture. Then there’s vomiting because of the pain, which causes more pain. This can last from four hours to three days. It’s a serious, neurological illness that affects about 16% of the population. Now we add bipolar disorder to that and the number jumps to 25%. You read that right. One-quarter of people with bipolar disorder also have to deal with migraines on a regular basis.
If you are one of those people, you may be part of a previously-uncategorized class of bipolar disorder. More and more studies are emerging that show there is not just a link between bipolar disorder and migraines, but that these patients have a very specific set of bipolar symptoms.
Bipolar disorder follows a spectrum. Symptoms and severity vary from person to person. One person may spend most of their time in depressive phases and only experience one manic phase their entire life, and another may deal constantly with mania and psychosis. That’s just in bipolar I. In bipolar II there’s hypomania and a higher likelihood of co-morbid anxiety. There’s cyclothymia, which is even less predictable, and bipolar disorder not otherwise specified. These patients can be more disadvantage because their symptoms and severity differ vastly and are therefore harder to treat.
Now bipolar disorder with co-morbid migraine may need to be added to that list. It comes with some fairly specific qualifications:
-Earlier age of onset
-Unstable, rapid cycling
-Higher chance of a co-morbid panic disorder
-More likely to have bipolar II
-Higher rate of attempted suicide
-Increasingly drug-resistant symptoms
-Worse overall health
So, if all of these symptoms exist across other types of bipolar disorder, why is this new qualification important? For a couple of reasons.
First, let’s talk about GABA. It doesn’t have anything to do with the kids’ t.v. show. GABA, in the most basic definition, is your body’s chill factor. It keeps your nervous system from getting overly excited. Without it, you get anxiety, depression, oh, and headaches. See where I’m going with this? You want GABA. You need GABA. Next, there’s NBEA. It’s a protein found on brain synapses that helps move things around, like GABA. NBEA happens to be located on the same chromosome as another gene, MAB21L1 and also close to the gene DCLK1. So if one is damaged, the others are more susceptible. If GABA is inhibited (due to damaged NBEA), this can also lead to, you guessed it, migraines and mood disorders. With gene-therapy being researched as the up-and-coming treatment mode for diseases, this link could prove incredibly important.
Gene-therapy has a long way to go before it becomes a common treatment. In the meantime, we have to rely on pharmacological treatments. In both bipolar disorder and migraines, medications can be hit-or-miss, depending on the individual. Finding the right drug, or drug combination, can take years. For most people, it’s an on-going process as symptoms can wax and wane over time. When you have co-morbid disorders, it becomes more complicated. Not only do you have to find the right treatment for one disorder, that treatment but you have to find one that doesn’t worsen another. For example, sumatriptan (Imitrex) is an often-used migraine treatment, but can occasionally cause serotonin syndrome-like symptoms when paired with other drugs that affect serotonin levels.
So what do we do? Well, fortunately, there are some drugs that have been shown to treat both disorders, though the use for both is generally off-label. Fewer pills to take? Count me in.
Most drugs that treat both bipolar disorder and migraines are anticonvulsants. For example, there is valproate (Depakote). It treats mood disorders and migraines, though the therapeutic dosages for each of these is different, so calibration can be difficult. Lithium can also alleviate symptoms for both bipolar disorder and migraines, but for some people it can actually worsen migraine symptoms. More examples of anticonvulsants are carbamazepine, lamotrigine, topiramate and gabapentin.
Just because these medications have some implications in treatment, they are still subject to the limitations involved in treating each of these disorders individually. For the best treatment, have multiple conversations with your doctor about the details of your symptoms. It takes time to tailor medication regimens, not just because they have varied efficacy for different people, but also because bipolar patients have difficulty determining what feeling “normal” feels like.
Talking to your doctor is important, not just for your specific treatment (though that is vital), but for treatment and research as a whole. The more bipolar patients communicate with their doctors about different symptoms and different disorders they have, the more researchers know what to focus on. More research leads to better research, which will lead to better treatment. So don’t just talk to your GP about your migraines and your psychiatrist about your bipolar disorder. Talk about all of your health to all of your caregivers. Your body is a system intertwined and cannot just be treated in parts. If this is indeed a new form of bipolar disorder, it needs to be recognized so patients can get the best care possible.