Comorbid Bipolar Disorder and Migraine: From Mechanisms to Treatment.

Jinfeng Duan,Chenxia Hu,Rongmei Yang,Lingfei Zhao,Shaohua Hu,Wenwen Lu

doi:10.3389/fpsyt.2020.560138

Abstract

Bipolar disorder (BD) is a severe psychiatric disorder characterized by recurrent episodes of manic/hypomanic or depressive symptoms and euthymic periods, with some patients suffering a gradual deterioration of illness and consequent cognitive deficits during the late stage. Migraine is a disease generally without abnormal medical examinations, neurological examinations or laboratory studies, and the diagnosis is made based on the retrospective demonstration of headache features and groupings of disease-associated symptoms. The epidemiology of comorbid BD and migraine is high and it is obligatory to find effective treatments to improve the prognosis. Recent investigations demonstrated that the close relationship between BD and migraine significantly increased the rapid cycling rates of both BD and migraine in patients. Although the detailed mechanism is complex and largely unclear in comorbid BD and migrain, genetic factors, neurotransmitters, altered signaling pathways, disturbances of inflammatory cytokines, and mitochondrial dysfunction are risk factors of BD and migraine. Particularly these two diseases share some overlapping mechanisms according to previous studies. To this end, we call for further investigations of the potential mechanisms, and more efforts are underway to improve the treatment of people with comorbid BD and migraine. In this review, we provide an overview of the potential mechanisms in patients with BD or migraine and we further discuss the treatment strategies for comorbid BD and migraine and it is obligatory to find effective treatments to improve the prognosis. This work will provide insights for us to know more about the mechanisms of comorbid BD and migraine, provides new therapeutic targets for the treatment and give clinicians some guidance for more appropriate and beneficial treatment.

Highlights

Bipolar disorder (BD) and migraine share multiple similar risk factors, including genetic factors, environmental risk factors, oxidative stress and disturbances of inflammatory cytokines
Parental migraine was associated with increased likelihood and a risk factor for offspring BD even in the absence of parental BD, the prevalence of migraine in the BD population may be as high as 39% and rapid cycling as a feature of bipolar disorder and comorbid migraine [10, 12, 13]
Multiple pathophysiological processes, such as genetic abnormalities, abnormal regulation of neurotransmitters, altered signaling pathways, reduced neurotrophic factors, inflammatory disturbances, mitochondrial dysfunction, cell apoptosis and impaired cell resilience, may be involved in the development of BD.Syntax Error (42364): Bad LZW stream - unexpected code. The interaction of these processes leads to abnormal neuronal function which may result in mood instability, disturbed energy metabolism, abnormal biological rhythms and cognition defects (Table 1)

Summary

INTRODUCTION

BD and migraine share multiple similar risk factors, including genetic factors, environmental risk factors, oxidative stress and disturbances of inflammatory cytokines Both diseases lead to decreased quality of life and multiple dysfunctions in humans (Figure 1). Bipolar disorder (BD) is a severe psychiatric disorder and characterized by recurrent episodes of manic/hypomanic (namely BD-I/BD-II, respectively) or depressive symptoms and euthymic periods, and some patients experience a gradual deterioration of illness and consequent cognitive deficits [1]. These 2 types of BD was distinguished according to the severity of manic symptoms. Parental migraine was associated with increased likelihood and a risk factor for offspring BD even in the absence of parental BD, the prevalence of migraine in the BD population may be as high as 39% and rapid cycling as a feature of bipolar disorder and comorbid migraine [10, 12, 13]

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