Headaches and Migraines May Have Strong Links to the 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.

“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. “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.

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, 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.

“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.”


Heidi Sutherland, Lyn Griffiths. It’s All About the Timing: Circadian Factors in Cluster Headache and Migraine. Neurology, 2023; 10.1212/WNL.0000000000207329 DOI: 10.1212/WNL.0000000000207329

American Academy of Neurology. “Do your headaches happen at the same time of day? Meta-analysis: Cluster headache, migraine have strong links to circadian system.” ScienceDaily. ScienceDaily, 30 March 2023. <www.sciencedaily.com/releases/2023/03/230330102139.htm>.

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