Migraine is highly circadian at many levels, with a circadian pattern occurring in one-half of attacks,
according to findings published in Neurology. Mark J. Burish, MD, PhD, and colleagues assessed circadian
features of cluster headache and migraine in a systematic review and meta-analysis as well as a genetic
analysis. For migraine, 2,698 of 5,385 participants across eight studies (50.1%) experienced a circadian
pattern of attacks, with a clear circadian trough between 23:00-07:00 and a broad circannual peak from
April to October. Chronotype varied significantly across studies. The researchers observed that, on the
system level, urinary melatonin levels were lower in individuals with migraine and even lower during an
attack. On the cellular level, migraine was associated with core circadian genes CK1δ and RORα, and 110
of 168 migraine susceptibility genes were clock-controlled genes. The findings show that migraine is
“highly circadian at multiple levels,” a finding that reinforces the role of the hypothalamus in this
condition, according to Dr. Burish and colleagues.
