Circadian rhythm and hypothalamus-related symptoms of migraine: A prospective study

Abstract Background: Hypothalamic symptoms and circadian rhythm in migraine are controversial。To use WeChat as a survey tool to explore the correlation between hypothalamus-related symptoms and migraine attacks and examine the circadian cycle of migraines. Methods: This prospective study enrolled migraine patients at the Headache Specialty Clinic, Neurology Department of Shandong Provincial Hospital, from November 2018 to January 2020. Each patient was required to report the migraine attack via WeChat for 3 months. At 08:00 every day, the WeChat mass texting function was used to send an inquiry about migraines in the past 24 h. If yes, a questionnaire was issued to obtain the details. The participants were assigned to the low (LFM) (≤5 days/month) and high (HFM) (>5 days/month) frequency migraine groups. Results: 162 participants completed the study. A total of 2875 migraine attacks were recorded. The HFM group showed more attacks at night (37.8% vs. 5.7%) and before dawn (25.5% vs. 7.9%) compared with the LFM group, while the LFM group had more attacks in the morning (53.5% vs. 11.7%) (P<0.001). Generally speaking, the two groups showed a reverse attack trend. Yawning was more frequent in the prodromal phase; facial sweating, conjunctival congestion, neck stiffness, photophobia, runny nose, nasal obstruction, and emotional changes were more frequent in the headache phase; inattention and fatigue were more frequent in the postdrome phase (all P<0.001). Conclusions: HFM and LFM display different migraine attack temporal patterns. Hypothalamus-related non-headache symptoms were present in all phases of migraine attacks. The rates of non-headache symptoms were significantly different in different phases.