Child Psychiatry Consult

Don’t ignore headaches in teens with bipolar disorder



ORLANDO – Canadian teenagers with bipolar disorder who reported having headaches also had more severe disease symptoms than did those who did not have headaches, according to an unpublished study.

"We echo previous calls for screening and identification of impairing headaches, such as migraines, among people with mood disorders for two reasons," Dr. Benjamin I. Goldstein, the study’s senior author, said in an interview.

"First, presence of impairing headaches may represent a subtype of bipolar disorder with unique course, characteristics, and perhaps treatment. Second, underrecognition and undertreatment of impairing headaches is well documented among adults with bipolar disorder, and our findings suggest the potential importance of treating these headaches among youth with bipolar disorder as well," said Dr. Goldstein, of Sunnybrook Health Sciences Centre, Toronto, whose poster was presented at the annual meeting of the American Academy of Child and Adolescent Psychiatry.

© Monkey Business Images Ltd./

Headaches in teenagers with bipolar disorder may be an indication of a more severe form of the disease, said Dr. Benjamin Goldstein.

Most of the studies so far have been done on adults, and not much is known about this possible association among teens, noted Dr. Goldstein and his coinvestigators.

They studied 55 outpatients aged between 13 and 19 years, with bipolar disorder I, II, or not otherwise specified (NOS). Roughly 60% of the patients were female.

Thirty-three of the teens, or 60%, reported headaches, and these individuals had significantly higher rates of intake depressions score, intake mania score, and global functioning score, the researchers found.

Also, these teens had significantly greater identity confusion, anger/depression, and disinhibition/persistence.

Meanwhile, nearly half of patients with BP-II reported headaches, compared with 18% of the patients with BP-I, and 36% of those with BP-NOS.

But psychiatric hospitalizations and psychosis rates showed an opposite trend. Teens without headaches had a significantly higher rate in both categories, compared with those who had headaches.

"This was a somewhat counterintuitive finding, given the other findings of increased illness severity among youth with headaches," Dr. Goldstein wrote. "Bipolar disorder shares numerous features with psychotic disorders as well as affective disorders, such as unipolar depression and anxiety. We could speculate that whatever causal factors are implicated in headaches among youth with bipolar disorder may be more closely linked with the depression and anxiety than they are with psychosis, which is a frequent precipitant of hospitalization."

The researchers wrote that there’s a need for longitudinal studies to identify specific BP symptoms most associated with headaches, in addition to identifying biomarkers that might help with understanding the pathophysiology. There’s also a need to "identify the possible need of specific treatments for youth with BP [who] suffer from comorbid headaches."

One of the study’s limitations was its cross-sectional design and lack of a comparison group, according to the authors.

Dr. Goldstein is a consultant for Bristol-Myers Squibb and has received honoraria from Purdue Pharma.

[email protected]

On Twitter @NaseemSMiller

Next Article: