Abstract
BackgroundMigraine is considered a disease with diurnal and 24 h pattern, though the existence of a prevalent circadian rhythm associated to migraine frequency and severity is still not clear. This observational cross-sectional study aimed to:1. Assess the circadian rhythm of migraine attacks onset in a large patients’ population selected in a headache center and including episodic and chronic migraine 2. Analyze the principal characteristic of the different onset time groups 3. Verify if migraine features, particularly those associated to chronic and disabling migraine, could be discriminant factors for time of onset group.MethodsWe selected 786 consecutive migraine outpatients, who correctly completed the headache diaries for 3 consecutive months and who fulfilled the diagnosis of migraine without aura-MO, migraine with typical aura alone or associated to migraine without aura - MO/MA and chronic migraine – CM. For the time of headache onset, we considered four time slots, from 6 to 12 am (morning), from 1 to 6 pm (afternoon), from 7 to 11 pm (evening), from 12 pm to 5 am (night), and an additional category named “any time”. Each time slot included the 60 min preceding the next one (e.g. an onset at 12.30 am was included in 6–12 am time slot). We evaluated in all patients the pericranial tenderness, anxiety and depression tracts, headache-related disability, sleep features, quality of life, allodynia and fatigue.ResultsWe scored a total of 16,578 attacks, distributed in the entire day. The most of patients, including CM, satisfied the criteria for the “any time” onset. Night onset was significantly less represented in the MA/MO group. Patients with prevalent night onset were significantly older, with longer migraine history and shorter sleep duration. Age and illness duration were the variables discriminating the different onset time groups.ConclusionsThe most of migraine patients do not report a specific circadian profile of attacks occurrence. Frequent migraine, severe disability, psychopathological tracts as well as central sensitization signs, do not match with a specific circadian rhythm of attacks onset. Night onset migraine seems to be an age related feature, emerging in the course of the disease.
Highlights
Migraine is considered a disease with diurnal and 24 h pattern, though the existence of a prevalent circadian rhythm associated to migraine frequency and severity is still not clear
We evaluated in all patients the total tenderness score (TTS), following the procedure described by Langermark and Olesen [16]
Demographic and clinical characteristics Among a total of 1250 patients who came at the time of visit booking, we considered data from 786 cases (Fig. 1)
Summary
Migraine is considered a disease with diurnal and 24 h pattern, though the existence of a prevalent circadian rhythm associated to migraine frequency and severity is still not clear. A recent study described the circadian rhythm of migraine patients, who used a on-smartphone headache diary This could be a reliable and handful method to assess migraine features [6]. In this study, both migraine and not migraine headache occurred preferentially in the early morning, though many acute headache episodes occurred during other hours, including night [6]. If patients are requested to distinguish acute migraine from continuous headache, they could indicate migraine onset time Another unclear point is the possible association between circadian rhythm and symptoms of central sensitization as allodynia and pericranial tenderness [9, 10]
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