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Cluster Headache, Migraine Highly Circadian

Circadian pattern of attacks identified, and circadian associations seen at systems and cellular levels

By Elana Gotkine HealthDay Reporter

THURSDAY, March 30, 2023 (HealthDay News) — Cluster headache and migraine are highly circadian, according to a review published online March 29 in Neurology.

Barlas Benkli, M.D., from UT Health Houston, and colleagues conducted a systematic review of 72 studies to examine circadian features of cluster headache and migraine. In addition, a genetic analysis for genes with a circadian pattern of expression (clock controlled genes [CCGs]) was conducted by cross-referencing 16 genome-wide association studies of headache, one nonhuman primate study of CCGs in various tissues, and 16 imaging reviews of brain areas relevant in headache disorders.

The researchers found that for cluster headache, a meta-analysis across 16 studies showed a circadian pattern of attacks in 70.5 percent of participants, with a clear circadian peak between 21.00 and 03.00, and with circannual peaks in spring and autumn. Across studies, chronotype was highly variable. Lower melatonin and higher cortisol levels were reported at the systems level. Cluster headache was associated with core circadian genes CLOCK and REV-ERBα at the cellular level; five of nine cluster headache susceptibility genes were CCGs. For migraine, 50.1 percent of participants across eight studies showed a clear circadian pattern of attacks, with a clear circadian trough between 23.00 and 07.00, and a broad circannual peak between April and October. Across studies, chronotype was highly variable. Urinary melatonin levels were lower in migraine participants at the systems level and were even lower during an attack. Migraine was associated with core circadian genes CK1δ and RORα at the cellular level; 110 of 168 migraine susceptibility genes were CCGs.

“These results raise the potential for using circadian-based treatments for headache disorders,” a coauthor said in a statement.

One author disclosed financial ties to Lundbeck.

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