Do we have a circadian rhythm in our Cluster Headache attacks?

A question I got from a contact of mine, Neurologist Mark J. Burish, M.D., Ph.D. It was about the circadian rhythm in our Cluster Headache attacks.

So do we always have our attacks at a certain time a day or are there any other patterns through the day?

I’ve been trying to get something visualized for at least half a year but didn’t manage. Don’t know what it is, I hope we’ll find someone who can make a model for us.

But I was looking at the plots that show how attacks are divided and saw that most members have certain times a day when more attacks seem to occur. Its when the white cloud of attacks, gets more to the edge of the plot.

Whats interesting to see is that there are many with intervals of 4 (Blue) and 6 hours (orange-red) This is only a visual and only based on a few different plots, but it seems interesting to me.

We can’t say we have a circadian rhythm in our Cluster Headache attacks yet. But it does show that its a question we can answer together.

What to do with the answer, is a new question. Maybe Mark can help us with that 😉

Update:

I got an answer by mail what we could do with this knowledge:
Thanks Rogier, with a clear rhythm we could do a couple things:

  1. Individual patients: try oral Sumatriptan or take a preventive medication just before the expected headache. In the United States, it’s hard to get a lot of injectable Sumatriptan. I’ve always been curious if taking a oral Sumatriptan would be helpful if taken before the headache started, or if I Verapamil medication would work better if the dose is timed to the headache.
  2. Research: just how clock-like is this headache? There are some laboratory models of some interesting circadian patterns with genetic mutations in circadian genes or circadian-related genes, I wonder if we really nailed down The details of it would resemble any of those.