Experts explain whether migraine attacks are ‘least likely to occur between 11pm-7am’

“In a systematic review and meta-analysis, migraine attacks were least likely to occur between 11 PM-7 AM. In addition, most migraine attacks occurred from late morning to early evening hours,” he said.

Migraine is strongly linked to circadian rhythm

1. In a systematic review & meta-analysis, migraine attacks were least likely to occur between 11 PM-7 AM. In addition, most migraine attacks occurred from late morning to early evening hours. #MedTwitter #neurotwitter #migraine

— Dr Sudhir Kumar MD DM (@hyderabaddoctor) May 7, 2023

Speaking with indianexpress.com, he said: “Studies are ongoing to study the efficacy of melatonin supplements in reducing headache frequency among migraine patients. However, individual patients have already reported the effectiveness of melatonin supplements in reducing headache frequency. But, we need to wait for results of high-quality randomised controlled trials before recommending for clinical use in migraine patients.”

In simple terms, circadian rhythm is a natural, internal process that regulates the sleep-wake cycle and repeats roughly every 24 hours. “It’s a biological clock that governs various physiological functions, including sleep, hormone production, body temperature, and metabolism,” said Dr Pradyumna Oak, director, Neurology, Nanavati Max Super Speciality Hospital, Mumbai.

Adding, Pavan Pai, Consultant Interventional Neurologist, Wockhardt Hospitals, Mira Road said that lack of sleep or insufficient sleep that is less than three hours has, in fact, been noted to trigger migraine problems. “Most migraines last anywhere from 30 minutes to six hours, making it extremely difficult to do daily activities with ease. Morning headaches are really common, probably because of triggers like dehydration or poor sleep, or that endorphins and some hormones dip to their lowest in the morning,” said Dr Pai.

However, Dr Santosh Sontakke, Neuro Physician at Ruby Hall Clinic said that in some cases, migraine may also present with no symptoms. “As a genetic disease, it has environmental triggers like sleep deprivation, lack of meal, stress, sunlight etc. But without any triggers, you can also get these types of headaches. One may get nausea or vomiting too,” said Dr Sontakke.

It is important to seek medical guidance (Source: Getty Images/Thinkstock)

Reiterating that individuals with sleep disorders or irregular sleep patterns may experience disrupted circadian rhythms, making them more susceptible to migraines at unconventional hours, Dr Oak said, “A well-regulated sleep-wake cycle and consistent bedtime routine could contribute to a decrease in migraine frequency and intensity during night-time hours.”

Another observation noted in this study was peaking of migraine attacks during April to October months, and lower frequency of migraine attacks from November to March.

“This also has been reported by patients during routine interactions in the OPD. April to July months coincide with summer and are relatively warmer as compared to November-March (which corresponds to winter and spring seasons in India). We have always assumed the increased heat during summer to be responsible for higher migraine attacks during the season; however, it would be interesting to study the effects of different seasons on circadian rhythm (and looking for differences between those who have increased headache frequency versus those who have no change in headache frequency),” Dr Kumar mentioned.

Agreed Dr Oak and elucidated that some individuals experience more migraine episodes during specific times of the year. “Factors such as increased heat, humidity, and longer daylight hours can trigger the condition in some. It can lead to dehydration, electrolyte imbalances, and disrupted sleep patterns, all of which are potential migraine triggers,” Dr Oak told indianexpress.com.

According to Dr Oak, conversely, winter may cause fewer migraines for some due to cooler temperatures and shorter daylight hours. “However, it is essential to recognise that individual experiences vary, and migraine triggers can differ from person to person,” said Dr Oak.

What can be done?

It is better to consult a doctor when migraine triggers and get the right kind of treatment, stressed Dr Pai. “Avoid self-medication and stick to the guidelines given by the doctor only. It is better to avoid stress and alcohol, eat a well-balanced diet, stay hydrated, and get a sound sleep at night,” Dr Pai said.

Dr Pai also shared that those with migraine must adopt healthy lifestyle practices. “You will see that the number of migraine attacks will reduce and you will be able to improve your quality of life,” added Dr Pai.

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