New research suggests that people with Bipolar I and a history of migraines should avoid taking lithium

A new study in brain and behavior has elucidated the relationship between migraines, bipolar disorder and patient outcomes. Nicole Sekula and colleagues conducted an 11-year longitudinal study that showed people with bipolar disorder and migraines had worse symptoms of depression, mania, and, on average, a reduced quality of life. When these people were also prescribed lithium, their symptoms of mania were worse than those with migraines who were not taking lithium.

About 30% of people with bipolar disorder also experience migraines, compared to about 17% of the general population. Previous research has found that people with migraines and bipolar disorder are more prone to major depression, suicidal thoughts, and anxiety disorders. Additionally, researchers have found that people with bipolar disorder and migraines are more likely to relapse when taking lithium for their bipolar diagnosis.

Sekula and colleagues felt additional research was needed to understand how this finding might affect patients. If lithium is found to increase symptoms in people with bipolar disorder and migraines, changes in treatment protocols are needed for those who meet the criteria.

The research team recruited 538 people diagnosed with Bipolar I. Thirty-one percent of the participant group suffered from migraines; the rest don’t. From 2005 to 2016, these participants completed bimonthly health questionnaires and measured mania and depression annually. Participants were divided into four comparison groups: those with migraines who took lithium, those without migraines who took lithium, those with migraines who didn’t take lithium, and those without migraines who took lithium. These four groups were then compared using the collected data on depression, mania and quality of life.

This process showed that people with migraines experience more depression, more mania, and lower quality of life scores than people without migraines. This was true regardless of whether lithium was used or not. Over an 11-year period, when subjects suffering from migraines were prescribed lithium, symptoms of mania were significantly worse than any other group in the study.

The research team identifies some limitations to consider. First, data was collected through self-reported migraine history and lithium use. Medical records were not used to verify participants’ claims. Research has found that self-report methods for chronic conditions are reliable, but medical records would have ensured the data were not biased.

Second, blood tests to determine the amount of lithium a person has ingested could have been valuable information. If blood tests revealed that participants were not taking their medication consistently, their data should not be included. Third, when people started getting migraines and when they started taking lithium was unknown. These data may have been helpful in understanding whether the timing of migraine onset was relevant to lithium use or poor outcomes.

Undeterred by these limitations, Sekula and colleagues recommend that lithium no longer be prescribed for bipolar I patients suffering from migraines. They state, “Our results, together with published observations, suggest that lithium is indeed contraindicated in comorbid bipolar disorder/migraine and other mood-stabilizing drugs should be considered.”

The study “Lithium Use Associated with Symptom Severity in Comorbid Bipolar I Disorder and Migraine” was authored by Nicole Sekula, Anastasia Yocum, Steven Anderau, Melvin McInnis, and David Marshall.