How Our Biological Clock Influences Cluster Headaches and Migraines
By AMERICAN ACADEMY OF NEUROLOGY
The study emphasizes the role of the hypothalamus and genetics in these headache disorders. Cluster headaches displayed a circadian pattern in 71% of people, peaking in late night and early morning, and were associated with two main circadian genes.
Migraine attacks followed a circadian pattern in 50% of people, peaking from late morning to early evening, and were also linked to two core circadian genes. The results suggest the potential for circadian-based treatments for headache disorders.
Meta-analysis: Cluster headache, migraine
have strong links to circadian system.
Both cluster headache and migraine have
strong links to the circadian system, the internal clock that regulates body
processes, according to a meta-analysis published in the March 29, 2023, online
issue of Neurology, the medical journal of the American Academy
of Neurology.
The meta-analysis included all available
studies on cluster headache and migraine that included circadian features. This
included information on the timing of headaches during the day and during the
year as well as studies on whether genes associated with the circadian clock
are more common in people with these headaches.
The researchers also looked at studies on
cluster headache and migraine and hormones related to the circadian system,
including cortisol and melatonin.
“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, PhD, 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.”
For cluster headache, the meta-analysis found a circadian pattern of headache attacks in 71% of people. Attacks peaked in the late hours of the night to early hours of the morning.
During the year, people
had more attacks in the spring and fall. On the genetic level, cluster headache
was associated with two main circadian genes, and five of the nine genes that
increase the likelihood of having cluster headache are genes with a circadian
pattern of expression.
People with cluster headache also had higher
cortisol levels and lower melatonin levels than people without cluster
headache.
For migraine, the meta-analysis showed a circadian pattern of attacks in 50% of people. While the peak for attacks during the day was broad, ranging from late morning until early evening, there was a circadian low point during the night when few attacks happened.
Migraine
was also associated with two core circadian genes, and 110 of the 168 genes
associated with migraine were genes with a circadian pattern of expression.
People with migraine had lower levels of
melatonin in their urine than people without migraine. In addition, melatonin
levels were lower during a migraine attack.
“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.”
A limitation of the study was that
researchers did not have information on factors that could influence the
circadian cycle, such as medications, other disorders such as bipolar disorder
or circadian rhythm issues such as night shift work.
Reference: “Circadian Features of Cluster
Headache and Migraine: A Systematic Review, Meta-analysis, and Genetic
Analysis” by Barlas Benkli, Sun Young Kim, Nobuya Koike, Chorong Han, Celia
Tran, Emma Silva, Yuanqing Yan, Kazuhiro Yagita, Zheng Chen, Seung-Hee Yoo and
Mark Joseph Burish, 29 March 2023, Neurology.
DOI: 10.1212/WNL.0000000000207240
The study was supported by the Will Erwin
Headache Research Foundation.