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24-Hour Distribution of Migraine Attacks
Karl Alstadhaug, MD., Rolf Salveson, MD, PhD,
Svein Bekkelund, MD, PhD
Posted: March 2008  
Headache 2008;48:95-100

Background   It is a widespread opinion that migraine attacks arise more frequently in the morning and that circadian rhythms may be responsible for the temporal pattern in migraine. However, only one small prospective study has previously been published on this topic.

Objective   To investigate circadian variation in migraine.

Method   Eighty-nine females in fertile age who had participated in a previous questionnaire-based study volunteered to prospectively record in detail every migraine attack for 12 consecutive months. We reviewed all diary entries covering the period from March 2004 through April 2005, and did time-series analysis.

Results   Fifty-eight patients had complete recordings over the 12 months, and 26 completed the diaries for 1-11 months. Three patients were excluded due to missing data and 2 patients were excluded due to chronic migraine or medication-overuse headache. A total of 2314 attacks were experienced, in average 27.5 per patient (range 1-75). By fitting a sine curve to the data there was a harmonic trend with a peak around 13.40 (1:40 P.M.) and the peak low ratio was 25.6 (95% CI:8.3-78.6).

Conclusion   The main finding in our study is that migraine attacks tend to recur in a harmonic 24-hour cyclic manner with a peak around the middle of the day and that there is no difference between migraine with aura and migraine without aura regarding this.