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July 2018

Cluster Headache Is in Part a Disorder of the Circadian System

Author Affiliations
  • 1Department of Neurosurgery, University of Texas Health Science Center at Houston
  • 2Department of Biochemistry and Molecular Biology, University of Texas Health Science Center at Houston
JAMA Neurol. 2018;75(7):783-784. doi:10.1001/jamaneurol.2018.1049

The daily rhythmicity, or circadian pattern, of cluster headache is a fascinating part of the disease. For example, a cluster headache patient from our clinic who was being interviewed about his headache attacks stopped and said quite confidently, “I get a headache every day at 11 am, and right now it’s 10:45. If you wait 15 minutes, I’ll show you what my headache looks like.” He had an attack at 11:38 am; after further discussion aided by his headache diary, it was clear that he could routinely predict his attacks within the hour. On a larger scale, a survey of 1134 cluster headache patients found that 82% had headaches at “more or less the same time each day.”1(p105) In that same survey, patients with episodic cluster headache were more likely to have headaches at the same time every year (usually in the spring or autumn). Therefore, the circadian system clearly appears to be involved in cluster headaches. In this article, we present several preliminary lines of evidence that the circadian system may be abnormal in patients with cluster headaches. Further investigation into these circadian abnormalities may be important in elucidating the full causative mechanism of this disorder and developing treatments for the disease.

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