Bipolar disorder; migraines and epilepsy are three prevalent conditions, of which little is understood about their pathophysiological processes. A recent literature review has explored the link between the conditions, and similarities were found in many areas including disease chronology and symptomatology; response to antiepileptic medication; and genes involved.

Comorbidities between two of the conditions are common, mainly involving migraine. Here, we present a middle-aged gentleman, seen in the outpatient department of a UK district general hospital, who suffers from severe symptoms of all three conditions. The patient has no other illnesses. Clinical difficulties have arisen in the diagnosis and treatment of his bipolar disorder. Management of his depressive episodes with simple selective serotonin reuptake inhibitors and mood stabilisers were either ineffective, or precipitated complicating adverse effects. The onset and progression of his illnesses suggests that a common underlying pathological process may exist, and presents a complex therapeutic problem.

Our case report therefore describes this clinical problem and our attempts at solving it. It also questions the possibility that bipolar disorder; migraines and epilepsy fall on the same spectrum of disorders. Further insight into the link and interactions between these three diseases would facilitate their diagnoses, and improve treatment strategies when they are presented as co-morbidities.