Clinical features and comorbidities associated with migraine in bipolar disorder: Results from the FACE-BD cohort

Individuals with bipolar disorder (BD) frequently experience comorbid medical conditions, with migraine being among the most common. While research on migraine prevalence in BD is growing, the associated clinical features, comorbidities, and treatments remain underexplored and sometimes inconsistent. This study aimed to investigate the clinical features and comorbidities associated with migraine in a large cohort of adults with BD.

We assessed 4348 outpatients with BD attending FondaMental Advanced Centers of Expertise. Sociodemographic and clinical data were collected using a standardized procedure. Lifetime diagnoses for medical disorders, including migraine, were based on self-reports, clinician assessments, and medical history reviews. Multivariable logistic regression was used to assess associations between migraine and sociodemographic factors, clinical characteristics, comorbidities, and medications.

The prevalence of comorbid migraine in BD was 20 %, with 29.1 % in BD type II and 19.9 % in BD type I. Multivariable analysis found that migraine was associated with younger age (OR = 0.98, CI 95 % 0.97-0.99), females (OR = 2.15, CI 95 % 1.56-2.95), sleep disturbances (OR = 1.06, CI 95 % 1.02-1.11), childhood trauma (OR = 1.01, CI 95 % 1.00-1.02), hypertension (OR = 1.88, CI 95 % 1.13-3.15), psoriasis (OR = 1.61, CI 95 % 1.01-2.56), asthma (OR = 1.65, CI 95 % 1.02-2.67) and lower use of second-generation antipsychotics (OR = 0.65, CI 95 % 0.48-0.87).

Migraine is common in BD, especially in younger individuals, females, and those with sleep disturbances or a history of trauma, who also experience a higher clinical burden. These overlapping factors highlight the need for an integrated treatment approach, addressing mood stabilization, sleep management, and trauma support to reduce migraine burden in BD patients.