Chronotypes and circadian timing in migraine

W. P.J. van Oosterhout*, E. J.W. van Someren, G. G. Schoonman, M. A. Louter, G. J. Lammers, M. D. Ferrari, G. M. Terwindt

*Corresponding author for this work

Research output: Contribution to JournalArticleAcademicpeer-review


Background: It has been suggested that migraine attacks strike according to circadian patterns and that this might be related to individual chronotype. Here we evaluated and correlated individual chronotypes, stability of the circadian rhythm, and circadian attack timing in a large and well-characterised migraine population. Methods: In 2875 migraine patients and 200 non-headache controls we assessed differences in: (i) distribution of chronotypes (Münich Chronotype Questionnaire); (ii) the circadian rhythm’s amplitude and stability (Circadian Type Inventory); and (iii) circadian timing of migraine attacks. Data were analysed using multinomial and linear regression models adjusted for age, gender, sleep quality and depression. Results: Migraineurs more often showed an early chronotype compared with controls (48.9% versus 38.6%; adjusted odds ratio [OR] = 2.42; 95% confidence interval [CI] = 1.58–3.69; p < 0.001); as well as a late chronotypes (37.7% versus 38.1%; adjusted OR = 1.69; 95% CI = 1.10–2.61; p = 0.016). Migraineurs, particularly those with high attack frequency, were more tired after changes in circadian rhythm (i.e. more languid; p < 0.001) and coped less well with being active at unusual hours (i.e. more rigid; p < 0.001) than controls. Of 2389 migraineurs, 961 (40.2%) reported early morning attack onset. Conclusion: Migraine patients are less prone to be of a normal chronotype than controls. They are more languid and more rigid when changes in circadian rhythm occur. Most migraine attacks begin in the early morning. These data suggest that chronobiological mechanisms play a role in migraine pathophysiology.

Original languageEnglish
Pages (from-to)617-625
Number of pages9
Issue number4
Early online date20 Mar 2017
Publication statusPublished - Apr 2018


The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by grants of the Netherlands Organization for Scientific Research (NWO) (VIDI 917.11.319 to G.M.T.) and the European Commission (EC) (FP7-EUROHEADPAIN - no. 602633). They had no role in the design or conduct of the study. The authors declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: W.P.J. van Oosterhout reports support for conference visits from Menarini and Allergan. G.G. Schoonman reports support for conference visit from Pfizer. M.A. Louter reports support for conference visits from Menarini and Allergan. G.J. Lammers is member of the international advisory board on Narcolepsy of UCB Pharma. M.D. Ferrari reports grants from Medtronic, and independent support from the Netherlands Organization for Scientific Research (NOW),National Institute of Halth (NIH), grant from the European Community, and the Dutch Heart Foundation. G.M. Terwindt reports support for conference visits from Menarini and independent support from NWO, ZonMW, the Dutch Heart Foundation and the Dutch Brain foundation. The other authors report no conflicts of interest.

FundersFunder number
Dutch Brain Foundation
Dutch Heart Foundation
European Community
National Institute of Halth
Netherlands Organization for Scientific Research
National Institutes of Health
Seventh Framework Programme602633
European CommissionFP7-EUROHEADPAIN
Nederlandse Organisatie voor Wetenschappelijk OnderzoekVIDI 917.11.319


    • chronotype
    • circadian rhythm
    • epidemiology
    • Migraine
    • sleep disorders


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