Both cluster headache and migraine attacks can appear like clockwork, a meta-analysis published in the journal Neurology suggests. The paper described a distinct circadian rhythm that regulates when pounding head pain strikes.
The meta-analysis included all available studies on cluster headache and migraine that included circadian features. It pooled together all of the evidence looking at timing, genetics, and associated hormones.
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“The data suggest that both of these headache disorders are highly circadian at multiple levels, especially cluster headache,” said study author Mark Joseph Burish, MD, of the University of Texas Health Science Center at Houston in Texas and a member of the American Academy of Neurology.
“This reinforces the importance of the hypothalamus—the area of the brain that houses the primary biological clock—and its role in cluster headache and migraine. It also raises the question of the genetics of triggers such as sleep changes that are known triggers for migraine and are cues for the body’s circadian rhythm,” Burish added.
Cluster Headache
More than 70 percent of people who live with cluster headache–excruciating pain that typically centers on one side of the face–exhibited a circadian pattern. This type of headache can last for hours, or even days. Patients can experience periods of remission, sometimes for years.
Late night into early morning tended to be the worst time of day for cluster headache patients. Attack frequency hit its peak in spring and fall, according to the data.
Cluster headache was linked to two main circadian genes. And a circadian pattern of expression was found for five out of the nine genes known to increase the risk of cluster headache. People with cluster headache also had higher cortisol levels and lower melatonin levels than average.
Migraine Headache
About half the subjects with migraine also demonstrated a circadian pattern. People with migraine experience severe, pounding pain, often on one side of the face. They may also have other symptoms such as nausea and sensitivity to light and sound. Hormonal changes, weather, alcohol, or various other “triggers” can bring on a migraine.
While time of day varied broadly among migraine patients, the most common times for an attack ranged from late morning through early evening. According to the meta-analysis, attacks were less common overnight when the migraine circadian rhythm hit a low point.
Migraine was linked to 110 of the 168 genes with a circadian pattern of expression, in addition to two core circadian genes. People with migraine also had lower levels of melatonin in their urine than average, which dropped even further during an episode.
Limitations, Future Study
Medication, working the night shift, or a comorbidity like bipolar disorder might also exert influence on the body’s clock systems, the researchers admitted. They said they’d like further study to see if this finding leads to anything useful for the 45 million Americans who live with headache.
“These results raise the potential for using circadian-based treatments for headache disorders,” Burish said. “This could include both treatments based on the circadian rhythm–such as taking medications at certain times of the day–and treatments that cause circadian changes, which certain medications can do.”
