2 a zigzag pattern in visual ﬁeld, narrowing of visual ﬁeld (tunnel view), blurred vision, and ﬂashes. Then, speech arrest follows and palsy develops starting with lips, face, neck, and extremities, mostly on the right site. Anterograde amnesia follows on such a phase which lasts some hours in diﬀerent degrees of severity. Speech arrest is usually the longest lasting symptom. Migraine headaches endure from 1 to 3 days. Manic states usually last a few days, depressive ones some weeks. In recent, MRI scan was nothing abnormal detected. EEG in symptom-free intervals revealed an unstable alpha rhythm but no major changes. Routine laboratory data and parameters for thyroid gland, borreliosis, and lues showed no abnormalities. In the case just described, the beginning of the bipolar disorder, presumably of type I, precedes the onset of migraine attacks. It is a migraine of a complicated type. In the diﬀerential, a familial hemiplegic migraine is possible. 3. Relationship between Migraine and Bipolar Disorder The literature broadly supports comorbidity of migraine and bipolar disorder. Datta and Kumar [5] reported on a 19- year-old patient with hypomania as an aura of migraine. In a review, Antonaci et al. [6] unravelled a coincidence of migraine and aﬀective anxiety disorders and, especially, a “trend towards an association of migraine and bipolar disorder” (see also [7]). Most studies support that migraine is associated not only with bipolar disorder but also with major depression, panic disorder, social phobia [8, 9], drug abuse [10], suicide, and neurological and internal diseases too, for instance stroke or hypertension [11]. Vice versa, according to a review of literature of McIntyre et al. [12], subjects with other neurological diseases, such as epilepsy or multiple scle- rosis, seem to have a higher occurrence of bipolar disorder. Are There Diﬀerences in Prevalence of Comorbidities? Dilsaver et al. [13] found a higher prevalence of migraine in bipolar patients than in those who suﬀer from major depressive disorder. In a study by Ortiz and colleagues [2], which distinguished bipolar I from bipolar II patients, a higher prevalence of migraine in bipolar II subjects was apparent and, in addition, higher rates were found for suicidal tendencies and anxiety disorders. Patients with a major depressive episode who had a family history of bipolar disorder had an increased risk of suﬀering from migraine [14]. Patients with unipolar depression and migraine have more depressive episodes in the course of time and more often a positive family history of migraine compared to those without comorbid migraine [15]. Does Migraine Inﬂuence the Course of Bipolar Disorder? Ac- cording to Brietzke et al. [16], patients with both bipolar I and bipolar II disorder who suﬀer from comorbid migraine had more mood episodes, especially depressive ones. Fur- thermore, they found a higher occurrence rate of other psychiatric and general medical comorbidities. Case Reports in Medicine 4. Is There a Common Aetiology of Bipolar Disorder and Migraine? Diﬀerent gene regions are suspect as being responsible for association of bipolar disorder with migraine, but results in studies diﬀer. One recent study [17] found no evidence that polymorphisms of the genes ANK3 and CACNA1C in migraine patients were associated with an elevated risk for bipolar disorder. Another recent study [18, 19], which inves- tigated genomewide associations, found some gene regions which diﬀered in bipolar patients depending on whether they were susceptible to migraine or not. Holland and Agius [20] saw “much overlap in neuropathological mechanisms” in both diseases. Besides genetics, they discussed altered expression of neurotrophic factors, cellular calcium physi- ology, endoplasmatic reticulum function, neuronal loss and pointed out the important question of sensitisation which is still controversially discussed: do recurrent episodes in either the diseases facilitate further ones? Others bring up white matter hyperintensities for discus- sion. Gunde et al. [21] argued that high rates of such signs, detected in neuroimaging, play an important role both in bipolar disorder and migraine, and a substantial proportion of the hyperintensities would be related to the comorbidity of both diseases. 5. Treatment Options for Comorbid Bipolar/Migraine Patients Although there are no evidence-based treatment suggestions for people with bipolar disorder and comorbid migraine, it seems reasonable that substances which act on both bipolar disorder and migraine could be used to ward oﬀ relapse. A problem in this approach is that the particular substances which are the drugs of choice for prophylactic treatment of migraine—the beta antagonists—could make depressive symptoms worse. On the other hand, valproate, which theoretically acts on both disorders, has only an oﬀ-label status in migraine prophylaxis [22]. Nevertheless, several papers see beneﬁts from valproate and other substances. Finocchi et al. [23] suggested valproate and topiramate as a mood stabilizer in migraine without aura and lamotrigine in migraine with aura. Even amitriptyline could be used for pre- vention of mood episodes and migraine attacks. Serotonin reuptake inhibitors (SSRIs) and serotonin norepinephrine reuptake inhibitors (SNRIs) are recommended in migraine patients for comorbid depression and anxiety. Caution should be exercised when triptans are combined with SSRIs or SNRIs because of a possible risk of serotonin syndrome [24]. In this vein, also neuroleptics which have already been used broadly as mood stabilizers are worth consideration, but, in relation to migraine, no suﬃcient studies exist [25]. Last but not least, the literature (see [26]) suggests that behavioural and cognitive-behavioural therapies are helpful for patients with a comorbid bipolar/migraine diagno- sis.