Headaches, the hypothesis of taking medicines before the “cursed” hour – breaking latest news

Summer time (which came into force on Sunday 26 March) can play tricks on those suffering from two forms of headache, cluster headacheknown for its gravity, e the migraine
, known for its diffusion, due to their close correlation with circadian rhythms, i.e. biological rhythms – such as the sleep / wake cycle or the light / dark cycle – which are the basis of our existence. An article just published in the magazine explains it Neurology by Japanese-American researchers directed by Mark Joseph Burish of the Texan University of Houston who, analyzing half a century of studies, were the first to give a precise numerical quantification to a truth known to anyone who deals with this disease: the worst enemy of headache sufferers is the change in the rhythms of life.

Weekend headache

Just think of the weekend headache: in migraine sufferers the pain punctually flares up on Saturdays and Sundays when you get up and have breakfast later and, above all, you don’t go to work, thus adding up three important triggering factors: alteration of sleep rhythms, caffeine withdrawal and decrease in stress. Texas researchers calculated that in general approximately 50% of migraine sufferers are affected by the irregular rhythms and not only on weekends; for those suffering from cluster headache the percentage rises to about 71%.

Daylight savings time

These two headaches may be affected by the transition to summer time because they follow the times dictated by hypothalamic clockthat is, from the biological clock that we have in the brain area called the hypothalamus which governs our rhythms not based on the clock we wear on our wrist, but on the light/dark cycleto that sleep/wake, at meal times, at work. Moreover, correlating them to hormonal and genetic factors, in turn linked to the environment and gender. We have known for a long time that the categories most at risk for cluster headaches are shift workers forced into a time lag of life, like the airline pilots of intercontinental flights.

Clock headache

Summer time is particularly insidious for this headache, because it is its strangest feature the punctuality that has earned it the nickname of clock headache given to her in the 1950s by neurologist Edmond Kunkle. The attacks tend to cluster within a well-defined time frame which Kunkle called cluster (or bunch) and hence the name cluster headache, cluster headache. With summer time we move the hands of the clock and therefore we throw the hypothalamus into confusion and the bunches can change.

The cursed hour

It happens, in fact, that if the first attack occurred for example at 3 pm on 25 March, many of the subsequent cluster attacks will come at the same time and it is easy for another to arise even at the same time of the same day of the following year. When patients notice this cyclicality they try in every possible way to distract the headache and, as the cursed hour approaches, they implement the most varied strategies, such as drawing pure oxygen from a cylinder which is one of the methods to quell attacks in the absence of drugs.

Hypothalamic gear

But, even if the patient manages to avoid the first attack, there will be others, all clustered at a short distance because as if that amount of time corresponded to a broken cog in the hypothalamic clock mechanism and when that missing tooth arrives the attack starts. The first to give a scientific explanation to what we have simplified with the example of the clock gear was the neurologist Arne May of the German University of Regensburg, who in 2001 with PET (positron emission tomography) discovered that this broken tooth actually the suprachiasmatic nucleusa small area of ​​the hypothalamus that becomes hyperexcited leading to attacks.

Advantages of rhythmicity

This may also have advantages. In addition to symptomatic treatments which must be quickly effective because this headache, also known as suicide, must be stopped immediately as it is very painful, there are also prophylaxis treatments to be taken every day. The study published in Neurology suggests that a window of time prediction of the attacks can pave the way for a circadian therapy, during which to intensify the prophylactic drugs in anticipation of the approaching cursed time. Japanese-American researchers calculated that in 70.5% of cases the attacks occur mainly in the evening and at dawn (from 8pm to 4am) and above all in autumn (30.7% of cases). In our hemisphere, spring and autumn are generally the worst times for the cluster headachewhile winter and summer are for the southern hemisphere, when instead Italians spend a period of well-being (unless they get on an intercontinental flight by changing time zone and season).

First in the world

The problem remains chronic drug-resistant attacks where patients have such severe hypothalamic abnormality that they go through hell between attacks, with no drugs taking effect. This was true until July 14, 2000 when the researchers of the Besta of Milan directed by Gennaro Bussone and Giovanni Broggi they were the first in the world to perform a functional neurosurgery technique called Dbs, an acronym for deep brain stimulationcio deep brain stimulation, which has since been adopted worldwide. Without the need for general anesthesia, an intracranial microelectrode is applied which inhibits the hyperactivity of the suprachiasmatic nucleus upon arrival of the bunch: The operation should be reserved for cases to be selected with careful clinical observation and a rigid evaluation protocol and certainly not for everything that 71% of patients indicated by the American study – comments Professor Bussone -. After so many years the results prove that the application of research to the clinic can open new horizons of hope to patients once considered incurable. The idea of ​​US colleagues of a circadian therapy in non-drug-resistant patients, and therefore excluded from DBS, could open up another of these horizons.