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Cephalalgia. 2019 May 29:333102419851815. doi: 10.1177/0333102419851815. [Epub ahead of print]

The biological clock in cluster headache: A review and hypothesis.

Author information

1
1 Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands.
2
2 Department of Neurology, Alrijne Hospital, Leiderdorp, the Netherlands.
3
3 Department of Psychiatry, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
4
4 Department of Molecular Cell Biology, Leiden University Medical Center, Leiden, the Netherlands.

Abstract

OBJECTIVE:

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

DISCUSSION:

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.

KEYWORDS:

Circadian; SCN; light; seasonal; sleep

PMID:
31142137
DOI:
10.1177/0333102419851815

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