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Migraine Comorbidity and Subsequent Diagnostic Conversion to Bipolar Disorder among Adolescents and Young Adults with Major Depression: A Nationwide Longitudinal Study

Mu-Hong Chen, Ju-Wei Hsu, Kai-Lin Huang, Ya-Mei Bai

Background: Migraine is commonly comorbid with major depression and bipolar disorder. Previous studies suggested that patients with migraine have a higher
prevalence of bipolar disorder, but the possible rôle of migraine comorbidity in the
diagnostic conversion to bipolar disorder among patients with major depression is
still unknown. Methods: With the Taiwan National Health Insurance Research Database, we enrolled 12,720 adolescents and young adults with major depression between 2002 and 2008 in this study. Totally, 2,120 patients had migraine comorbidity
and 10,600 (1: 5) age- and sex-matched patients did not. We followed up the study
subjects to the end of 2011, and identified those who developed bipolar disorder during the follow-up. Results: Cox regression analysis with adjustment of demographic
data and psychiatric comorbidities showed that patients with major depression and
migraine had significantly more diagnostic conversion to bipolar disorder (hazard
ratio = 1.31, 95% confidence interval = 1.16 - 1.48, p = 0.001) than those without
migraine. Furthermore, those MDD patients with conversion to bipolar disorder
were found to be significantly more comobid with anxiety disorder (HR = 1.68, 95%
CI = 1.49 - 1.88, p < 0.001), to be significantly more comorbid with substance use
disorder (HR = 2.34, 95% CI = 1.98 - 2.76, p < 0.001), to be significantly more comorbid with alcohol use disorder (HR = 1.70, 95% CI = 1.37 - 2.10, p < 0.001), to
be significantly more disrupted behavior disorder (HR = 1.50, 95% CI = 1.01 - 2.11,
p < 0.05), and to be more comorbid with attention deficit/hyperactivity disorder (HR
= 1.91, 95% CI = 1.41 - 2.59, p, p < 0.001). Discussion: The comorbidity of migraine among adolescents and young adult patients with major depression increased
the risk of developing subsequent bipolar disorder, compared to those without migraine. Migraine comorbidity may be a clinical marker to indicate the bipolar trait
among major depression patients.
Key Word migraine, major depression, bipolar disorder, diagnostic conversion
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