Why do CH appear after falling asleep ?

[john2000]

Hi, 

 

I take about 6mg of melatonin before i go to sleep. Sometimes at 11 , sometimes at 10, ,,,but many times if I had a CH that day, it will return and wake my up ussually 12:30am.

 

Is this just coincidence regarding the exact time ? 

Any tips for prevention of night attacks?

I may have CH at 10am , then 12PM ,but almost always a night attack  around 12:30am after falling asleep .

 

If I dont have a CH day time , its very rare that I would get one at night.

 

 

 

Thank you.

[Racer1_NC]

Hits while sleeping generally occur when one hits REM sleep......

[CHfather]

6 mg is a relatively small dose of melatonin.  In the studies showing melatonin efficacy, I'm pretty sure that 9-10mg was the standard.  There are people here who take as much as 30mg.  So, you might try a somewhat higher dosage and see if that helps.  OTC melatonin varies greatly in quality and in delivery methods (timed release vs. immediate; dissolved in mouth vs chewable vs just swallow it), so several sites recommend, >>If one brand of commercial melatonin does not work another should be tried because the true amount of melatonin in various OTC brands varies widely.<<  It's possible that the closer to your bedtime you can take them, the more effective they'll be.

 

All of the preceding of course contains the usual qualifier, "or maybe not."

[john2000]

Thanks,

 

I 'll try bigger dosage.

 

Should you continue with higher dosage when you are not in the headache cycle? When mine ends, i may have even 2 month or more before the next one starts. Night CH makes me so tired that i have to skip work . That means 2 days in a row, opposed to 1 day when they occur only day time. 

 

Thank for your help,,,I hope I m not too annoying with my questions, I 'll probably have little  more in regards to vit D regiment. 

Thank you . 

[CHfather]

I'm pretty sure that you only need to take melatonin during a CH cycle.  I don't recall seeing any evidence that taking it between cycles will prevent a cycle. Others who use melatonin will be able to tell you if I'm wrong, which as you have seen is not unknown.  You generally do want to continue the D3 between cycles to sustain a high enough level in your system (if that was going to be part of your question).

[amon10]

Definitely John2000 about the REM sleep, I work swing shift and don't matter for me what time of day. When in cycle I get 90% of my attacks when entering deep sleep no matter when I go to bed.

[1 Last Song]

Sleep and clusters don't mix well since REM phase sleep is a trigger. You cannot 'Skip" REM phase sleep neither. For some reason, the brain absolutely requires some REM sleep. Without any REM phase sleep, you will die within weeks or perhaps a few months .. but again, the body and brain NEEDS REM phase sleep.. Sleeping aids will not allow you to skip REM phase sleep. Sleeping with a CPAP machine or low flow oxygen on may help increase your O2 levels while sleeping thus preventing some nighttime attacks.

[john2000]

1.How is melatonin helping , if it's just helps us to fall asleep ? 

2.Do we know what is it spefically that casues CH during REM ?

 

thanks,

[CHfather]

1. Melatonin levels are low in people with CH (and migraines, too).  Melatonin is related to a whole bunch of pain and brain systems, including the hypothalamus.  So it's not just helping you fall asleep, it's dealing with a hormone imbalance (melatonin is a brain hormone).   Here's an abstract from a 2006 article:

>>There is increasing evidence that headache disorders are connected with melatonin secretion and pineal function. Some headaches have a clearcut seasonal and circadian pattern, such as cluster and hypnic headaches. Melatonin levels have been found to be decreased in both migraine and cluster headaches. Melatonin mechanisms are related to headache pathophysiology in many ways, including its anti-inflammatory effect, toxic free radical scavenging, reduction of pro-inflammatory cytokine upregulation, nitric oxide synthase activity and dopamine release inhibition, membrane stabilisation, GABA and opioid analgesia potentitation, glutamate neurotoxicity protection, neurovascular regulation, 5-HT modulation and the similarity in chemical structure to indometacin. The treatment of headache disorders with melatonin and other chronobiotic agents, such as melatonin agonists (ramelteon and agomelatin), is promising and there is a great potential for their use in headache treatment.<<  https://www.ncbi.nlm.nih.gov/pubmed/16548786

 

2. Here's what a major headache center says about sleep and CH: http://www.mhni.com/headache-pain-faq/cluster-headaches/cluster-headache-sleep

Here's a very long, more recent analysis of CH and sleep.  https://thejournalofheadacheandpain.springeropen.com/articles/10.1186/s10194-015-0562-0

Among its findings is this:

>>Inspired by anecdotal and clinical experience, sleep studies in CH have been conducted but results are diverging [12]. Anecdotally, patients awakened by nocturnal attacks often lucidly recall dreams and typically report that these occur one to two hours after falling asleep. These sporadic observations have led to the belief that nocturnal attacks of CH are temporally related to the rapid-eye-movement (REM) sleep phase, the first of which typically occurs roughly one hour after sleep onset. The possible connection with REM-sleep [16, 17, 18] and sleep apnea [17, 19, 20, 21, 22] is based on relatively small studies which are mostly uncontrolled. It appears that while a temporal association between individual CH attacks and nocturnal sleep (but not necessarily REM-sleep) is evident, little is known about the specifics of this link.<<

 

FWIW, when my daughter is having predictable attacks in the early nighttime (such as your 12:30 ones), she stays awake so they are easier to abort with oxygen and energy shots. She does not usually have another attack then after she falls asleep.  Quite often, one person's experience doesn't translate to anyone else, so I'm just mentioning this, as I say, FWIW.