The Biological Clock and Cluster Headache.

Located deep in the center of the brain is the Pineal Gland which is also called the “Biological Clock.”  The pineal gland secretes melatonin, a brain neurochemical, that helps regulate the human biological clock, and which provides the so-called “circadian rhythm.”

What makes cluster headaches come several hours after going to sleep at night or during the day at the same time day after day?

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This is an article by Britt Talley Daniel MD, retired member of the American Academy of Neurology, the American Headache Society, migraine textbook author, podcaster, YouTube video producer, and blogger.

Cluster Headache (CH) activates the pineal gland so that Cluster Headaches as a general rule come on 1-2 hours after going to sleep at night or at the same time during the day. Cluster Headaches start at the same time of the year, such as the Spring, in April or May, for many persons every year.

Related Questions.

What is the usual occurrence of Cluster Headache like?

For a person going to bed at 10 PM, cluster headache might wake the afflicted individual out of sleep at about midnight with the usual, one-sided, terrific headache with associated autonomic symptoms. Then during the day the headaches might come back at 10:00, 14:00, and 20:00.

Some persons with CH have up to 8 similar attacks a day for 6-12 weeks.

To learn more read my website article, “Cluster Headache” at www.doctormigraine.com. Please click here to read.

What determines the amount of melatonin the brain makes?  The amount of light a human brain is exposed to determines the amount of melatonin produced.

Where does the word “circadian” come from?  The term circadian comes from the Latin “circa” which means “around” or “approximately.”

What is the circadian rhythm?  The circadian rhythm is a natural, internal process that sets the sleep-wake cycle.  The cycle repeats approximately every 24-hours and is important for general health.  It drives internal physiological process, the internal organs, and the brain.

Circadian rhythms are endogenous or "built-in" and are set to a person’s environment by external cues called zeitgebers, from the German, "time giver."  Zeitgebers are light and temperature.

What is the anatomic location of the Circadian, biological clock, system?  The circadian system is controlled by the suprachiasmatic nuclei (SCN), a bilateral structure located at the base of the anterior hypothalamus.

What are the biological clock, circadian medical problems?

In medical science, an abnormal circadian rhythm in humans is known as circadian rhythm disorder.  Examples of Circadian rhythm disorders are:

Jet lag disorder

Shift work disorder

Altered sleep phase disorder

Depression

Mood Disorders—Bipolar Disorder

What is the literature linking Cluster Headache to the circadian rhythm?

Mark J. Burish, MD, PhD; Zheng Chen, PhD; Seung-Hee Yoo, PhD wrote in JAMA Neurol. 2018;75(7):783-784 on Cluster Headache Is in Part a Disorder of the Circadian System.

FullText

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.”

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.

Tamara Pringsheim wrote in Review Can J Neurol Sci. 2002 Feb;29(1):33-40 on Cluster headache: evidence for a disorder of circadian rhythm and hypothalamic function.

Abstract

This article reviews the literature for evidence of a disorder of circadian rhythm and hypothalamic function in cluster headache. Cluster headache exhibits diurnal and seasonal rhythmicity. While cluster headache has traditionally been thought of as a vascular headache disorder, its periodicity suggests involvement of the suprachiasmatic nucleus of the hypothalamus, the biological clock.

Normal circadian function and seasonal changes occurring in the suprachiasmatic nucleus and pineal gland are correlated to the clinical features and abnormalities of circadian rhythm seen in cluster headache. Abnormalities in the secretion of melatonin and cortisol in patients with cluster headache, neuroimaging of cluster headache attacks, and the use of melatonin as preventative therapy in cluster headache are discussed in this review.

While the majority of studies exploring the relationship between circadian rhythms and cluster headache are not new, we have entered a new diagnostic and therapeutic era in primary headache disorders. The time has come to use the evidence for a disorder of circadian rhythm in

cluster headache to further development of chronobiotics in the treatment of this disorder.

Abstract Circadian rhythms of physiology are key to health and fitness, as dysregulation, by genetic mutations or environmental factors, increases disease risk and aggravates progression. Molecular and physiological studies have shed important light on an intrinsic clock that drives circadian rhythms and serves essential roles in metabolic homeostasis, organ physiology, and brain functions.

One exciting new area in circadian research is pain, including headache and neuropathic pain for which new mechanistic insights have recently emerged. For example, cluster headache is an intermittent pain disorder with an exceedingly precise circadian timing, and preliminary evidence is emerging linking several circadian components with the disease.

In this review, we first discuss the broad metabolic and physiological relevance of the circadian timing system. We then provide a detailed review of the circadian relevance in pain disease and physiology, including cluster headache, migraine, hypnic headache, and neuropathic pain. Finally, we describe potential therapeutic implications, including existing pain medicines and novel clock-modulating compounds.

The physiological basis for the circadian rhythms in pain is an exciting new area of research with profound basic and translational impact.

Willemijn C Naber, Rolf Fronczek, Joost Haan, wrote in Cephalalgia 2019 Dec;39(14):1855-1866 on The biological clock in cluster headache: A review and hypothesis.

Abstract

To review and discuss the putative role of light, sleep, and the biological clock in cluster headache.

Cluster headache attacks are believed to be modulated in the hypothalamus; moreover, the severe pain and typical autonomic cranial features associated with cluster headache are caused by abnormal activity of the trigeminal-autonomic reflex. The temporal pattern of cluster headache attacks suggests involvement of the biological clock, and the seasonal pattern is influenced by the number of daylight hours. Although sleep is often reported as a trigger for cluster headache attacks, to date no clear correlation has been established between these attacks and sleep stage.

Conclusions

We hypothesize that light, sleep, and the biological clock can change the brain’s state, thereby lowering the threshold for activating the trigeminal-autonomic reflex, resulting in a cluster headache attack. Understanding the mechanisms that contribute to the daily and seasonal fluctuations in cluster headache attacks may provide new therapeutic targets.

Summary

Cluster headache is the worst headache in the world, when it comes, it may come many times a day, and it locks into the human biological clock.

To learn more about treating CH, read my website article, “Does Emgality Help Cluster Headaches?” at www.doctormigraine.com. Please click here to read.

Did you know that plain old oxygen delivered via a nasal cannula can treat CH? Read my website article, “Does Oxygen Work For Cluster Headaches?” That is at www.doctormigraine.com. Please click here to read.

For persons with CH who do not want to take an oral medication but prefer a medical device, did you know that there is ”GammaCore for Migraines and Cluster Headaches?” It is on my website, www.doctormigraine.com. Please click here to read.

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All the best.

Britt Talley Daniel MD