Circadian variations in the clinical presentation of headaches among migraineurs: A study using a smartphone headache diary

ABSTRACT

Migraines occur within certain time frames. Nevertheless, information regarding circadian variation in the clinical presentation of migraine is limited. We investigated circadian variations in the clinical presentation of migraine using a smartphone headache diary (SHD). We enrolled adult participants with the diagnosis of migraine according to the third beta edition of the International Classification of Headache Disorders. Participants were asked to log in to the SHD every day for 90 days to record the occurrence of headaches. We compared the occurrence and clinical presentation of headaches during four 6-hour quadrants per day (00:00–05:59, 06:00–11:59, 12:00–17:59, and 18:00–23:59). Migraine-type headache was defined as a headache attack that fulfilled all criteria of migraine, except for the criterion regarding typical headache duration. Eighty-two participants kept a dairy for at least 50% of the study period and recorded 1491 headache attacks. Among the 1491 headache attacks, 474 (31.8%) were classified as migraine-type headaches and 1017 (68.2%) were classified as non-migraine-type headaches. All headaches, migraine-type headaches and non-migraine-type headaches occurred most frequently between 06:00 and 11:59, and least frequently between 18:00 and 23:59, and between 00:00 and 05:59. Migrainous headache characteristics, such as unilateral pain, pulsating quality, severe headache intensity, aggravation by movement, nausea, photophobia, and phonophobia presented most frequently between 06:00 and 11:59, and least frequently between 18:00 and 23:59, and 00:00 and 05:59 among 1491 all headache attacks. Headache clinical presentation as well as headache occurrence exhibited circadian periodicity among migraineurs.

Abbreviations: SHD: smartphone headache diary; ICHD-3 beta: the third edition beta version of the International Classification of Headache Disorders

Keywords:

• Chronobiology
• migraine
• temporal pattern
• headache
• circadian

Acknowledgments

The authors thank Sarang Shin, Kyeongok Jo, and Juyeon Park for their assistance in data management, and M2Community Co., Ltd. for the development of the smartphone application-based headache diary.

Authors’ contributions

J-WP conceived and designed the study, collected and analysed data, and drafted the manuscript. S-JC conceived and designed the study, collected and analysed data, and drafted the manuscript. S-GP analysed data and wrote the manuscript. MKC conceived, designed the study, analysed data, and wrote the manuscript. All authors read and approved the final manuscript.

Declaration of interest

Dr. Jeong-Wook Park declared no conflict of interest.

Dr. Soo-Jin Cho was involved as a site investigator of multicentre trial sponsored by Otsuka Korea, Eli Lilly and Company, Korea BMS, and Eisai Korea, and received research support from Hallym University Research Fund 2016 and received lecture honoraria from Yuyu Pharmaceutical Company.

Dr. Sang-Gyu Park declared no conflict of interest.

Dr. Min Kyung Chu was as a site investigator for a multicentre trial sponsored by Eli Lilly, worked an advisory member for Teva, and received lecture honoraria from Allergan Korea and Yuyu Pharmaceutical Company.

Additional information

Funding

This study was supported by a grant from the Korean Headache Society and by the Hallym University Research Fund (grant number HURF-2014-51).