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Current Understanding of the Chronobiology of Cluster Headache and the Role of Sleep in Its Management

Authors Barloese M

Received 2 December 2020

Accepted for publication 15 January 2021

Published 11 February 2021 Volume 2021:13 Pages 153—162


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Dr Sarah Appleton

Mads Barloese1,2

1Department of Clinical Physiology and Nuclear Medicine, Center for Functional and Diagnostic Imaging, Hvidovre Hospital, Hvidovre, Denmark; 2Department of Neurology, Danish Headache Center, Rigshospitalet-Glostrup, Glostrup, Denmark

Correspondence: Mads Barloese
Funktions- Og Billeddiagnostisk Enhed, Hvidovre Hospital, Kettegaard Alle 30, Hvidovre, DK-2650, Denmark

Abstract: Cluster headache is uniquely rhythmic in its occurrence both diurnally and annually. This has implications for the clinical approach to the patient but also for our understanding of the role of central structures in its pathological basis. Many intrinsic and extrinsic factors seem to influence CH rhythmicity, including genetics. The proclivity for attacks to occur at night and the possible association with particular sleep phenomena, including sleep apnea, have motivated a number of studies which has improved our understanding but many questions remain unanswered. The sleep-headache interaction seems to be bidirectional and possibly both direct and indirect. The latter could involve more disperse networks of homeostatic regulation, which may better encompass recent observations. Treatment of the headache patient with concurrent sleep problems can be particularly challenging, especially considering side-effects and interactions of commonly used medications. While current treatment guidelines do not incorporate chronotherapeutic thinking, some evidence may suggest that application of such principles on an individual level may be beneficial.

Keywords: cluster headache, chronobiology, sleep, chronotherapy

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