Hindawi Publishing Corporation Case Reports in Medicine Volume 2012, Article ID 389851, 3 pages doi:10.1155/2012/389851 Case Report Bipolar Affective Disorder and Migraine Birk Engmann Department of Neurology, Fachklinikum Brandis, Am Wald, 04821 Brandis, Germany Correspondence should be addressed to Birk Engmann, birk.engmann@web.de Received 2 January 2012; Revised 9 March 2012; Accepted 11 March 2012 Academic Editor: B. Carpiniello Copyright © 2012 Birk Engmann. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. This paper consists of a case history and an overview of the relationship, aetiology, and treatment of comorbid bipolar disorder migraine patients. A MEDLINE literature search was used. Terms for the search were bipolar disorder bipolar depression, mania, migraine, mood stabilizer. Bipolar disorder and migraine cooccur at a relatively high rate. Bipolar II patients seem to have a higher risk of comorbid migraine than bipolar I patients have. The literature on the common roots of migraine and bipolar disorder, including both genetic and neuropathological approaches, is broadly discussed. Moreover, bipolar disorder and migraine are often combined with a variety of other aﬀective disorders, and, furthermore, behavioural factors also play a role in the origin and course of the diseases. Approach to treatment options is also diﬃcult. Several papers point out possible remedies, for example, valproate, topiramate, which acts on both diseases, but no ﬁrst-choice treatments have been agreed upon yet. 1. Introduction Both bipolar disorder and migraine are not uncommon diseases. Whereas disorders of bipolar spectrum have an oc- currence rate between 0.4 and 1.4% depending on diﬀerent studies [1], migraine has rates from 10 to 30% [22]. More often than noticed, bipolar disorder occurs together with migraine. In a study of patients suﬀering from bipolar dis- order (both type I and II), Ortiz et al. [2] found comorbid migraine in 24.5% of all bipolar cases and McIntyre et al. [3] of 24.8% (versus a general population rate of 10.3%). Contrary to that, Holland et al. [4] found a much lower pre- valence of 4.7%. Nevertheless, comorbidity of both dis- eases seems to be an underestimated problem. In short, the main characteristics of bipolar disorder are recurrent episodes of depressive and manic states. Migraine is a usual- ly unilateral headache often combined with nausea, photo- phobia, and others. As with bipolar disorder, migraine is divided into diﬀerent subtypes, such as migraine with aura and without, or familial hemiplegic migraine among others. 2. Case History A patient in his middle ﬁfties has been suﬀering from mood disturbances since adolescence. The patient’s family history hints of “nerve diseases” of his mother and of his aunt and grandmother on the mother’s side. For several days, he was overactive and, as his brother once told him, “mad.” The patient, during his hyperactive phase, often tried to convince his brother to do wayward things. After some days of hyperactivity, the patient’s mood switched overnight to being deeply depressed, with avolition and a gloomy mood that lasted for many weeks. When this pattern ﬁrst appeared, it occurred every one or two months; but, in its later appear- ances, the switching occurred monthly or within a fortnight. The patient never underwent therapy. At the age of 20, he had a head injury caused by an accident with his motorcycle. (More speciﬁc data about this event were not available.) After that, a migraine developed, which at ﬁrst was never severe, and occurred four times a year. These early migraines occurred independently of his bipolar disorder. In the last ten years, however, the migraine became extremely severe on occasion and was linked to his bipolar disorder. The linkage is that manic states were always followed by migraine attacks with depressive mood. With these severe migraines, the patient experiences withdrawal, loss of interests, sleep distur- bances, and recurrent suicidal fantasies. In addition to these migraines which follow after manic states, other migraines occur independently of manic states. In these last ten years, severe migraine attacks begin with aura symptoms such as