Migraine, Cluster, Tension-Type, and Hypnic Headaches: A Complete Timeline Guide

1. Detailed Attack Characteristics

Feature	Migraine	Tension-Type Headache	Cluster Headache	Hypnic Headache
Duration Range	• General range: 4-72 hours • Non-perimenstrual women: 16 hours (median) • Perimenstrual women: 23 hours (median) • Men: 14 hours (median) • Chronic migraine: 44.4 hours (average)	• Episodic: 30 min - 7 days • Chronic: Hours to days or unremitting • Duration affected by central sensitization	• Standard: 15-180 minutes • Longer durations in women • Extended in those with migraine features	• Range: 15 min - 4 hours • Consistent timing pattern • Similar duration to cluster headache
Daily Timing Pattern	• Morning predominance (6:00-12:00 AM) • Afternoon onset in children • Night predominance in elderly	• No consistent daily pattern • Can be affected by sleep disorders • May be influenced by stress patterns	• Strong nighttime pattern (9 PM-2 AM) • Often during first REM sleep phase • Predictable timing within individuals	• Strictly nocturnal (1:00-5:30 AM) • Occurs ≥4 nights/week • Highly predictable timing
Seasonal Variations	• Light season predominance (MA) • Peaks: November to January • Nadir: July • Spring/autumn variations reported	• No clear seasonal pattern • Limited chronobiological evidence • May be affected by stress cycles	• Strong spring/fall pattern • Lower frequency in summer • Linked to daylight patterns • Influenced by photoperiodism	• No clear seasonal pattern reported • Consistent year-round occurrence • Focus on nocturnal timing
Age & Gender Specifics	• Peak onset: Women 20-24, Men 15-19 • Median onset: Women 25, Men 24 • F:M ratio = 3:1 • Earlier onset may indicate worse prognosis	• Mean onset: 29.1 years • Men: 29.8 years • Women: 28.5 years • F:M ratio = 1.2:1	• Mean onset: ~30 years • Men: 29.7 years • Women: 30.3 years • M:F ratio = 4:1	• Late-life onset: 44-86 years • Distinct from other headache types • Gender ratio not well established

2. Pathophysiological Mechanisms

Headache Type	Central Mechanisms	Peripheral Mechanisms	Genetic/Molecular Factors
Migraine	• Hypothalamic activation • Salience network involvement • EEG slowing during attacks • Brain excitability changes	• Estrogen level fluctuations • Vascular inflammatory markers • Higher PTX-3 levels in shorter attacks • Trigeminovascular activation	• G10 T (intron 23) genotype • GPX1 gene polymorphisms • Oxidative stress genes • 35-60% heritability
Tension-Type	• Alpha2-adrenergic mechanisms • Central sensitization • Limited chronobiological patterns	• Myofascial trigger points • Peripheral sensitization • Muscle tension involvement	• Lower genetic influence • Higher heritability without migraine • Specific genes unknown
Cluster	• Strong hypothalamic involvement • SCN regulation of circadian rhythm • Increased grey matter volume	• Retinal light sensitivity • Vitamin D deficiency correlation • Autonomic system involvement	• CLOCK gene variations • HCRTR2 involvement • PER3 component effects • MERTK gene influence
Hypnic	• Circadian rhythm involvement • Sleep-wake cycle connection • Distinct from REM patterns	• Limited understanding • No autonomic involvement • Differentiates from cluster	• Genetic factors not well studied • Limited molecular understanding

3. Disease Evolution & Treatment Implications

Aspect	Disease Evolution	Clinical Characteristics	Treatment Considerations
Migraine	• 46% persistence in 10-year follow-up • 14% have migraine attack remission • Changes in attack characteristics • Pattern changes with age	• Shorter duration in children • More bilateral in elderly • Less severe with aging • Changes in autonomic features	• Early treatment more effective • Timing affects treatment response • Consider chronotype in prevention • Age-specific approaches needed
Tension-Type	• Higher remission than migraine • 32% retain diagnosis at 5 years • 29% achieve remission • May transform to other types	• Consistent features across ages • Less variation in presentation • Frequency peaks at 30-39 years	• Focus on trigger point treatment • Address central sensitization • Consider comorbid conditions
Cluster	• 33% achieve remission • Mean remission age: 42 years • Features may decrease over time • Pattern may become less predictable	• Strong chronobiological features • Distinct circadian/circannual patterns • Clear seasonal variations	• Time preventive treatment with cycles • Consider chronotherapy • Account for seasonal patterns
Hypnic	• Late-life onset pattern • Consistent timing maintained • Long-term evolution less studied	• Strictly nocturnal occurrence • Regular timing pattern • No autonomic features	• Focus on sleep-related interventions • Consider age-related factors • Timing of preventive measures

4. Environmental & Trigger Factors

Factor Category	Impact on Timing	Clinical Relevance
Light Exposure	• Affects circadian rhythms • Influences seasonal patterns • Important in cluster headache cycles • Affects migraine with aura	• Consider light management strategies • Important for preventive planning • Relevant for treatment timing
Sleep Patterns	• Triggers cluster headache attacks • Affects migraine frequency • Critical in hypnic headache • Influences attack timing	• Sleep hygiene importance • Treatment timing considerations • Prevention strategies
Hormonal Cycles	• Menstrual migraine timing • Affects attack duration • Influences frequency patterns • Age-related changes	• Hormonal treatment timing • Preventive strategy planning • Life-stage considerations
Stress Patterns	• Work-related timing • School stress in children • Seasonal stress variations • Daily stress cycles	• Stress management timing • Prevention planning • Lifestyle modifications

Note: This table summarizes findings from a 2024 comprehensive review published in Cephalalgia: https://journals.sagepub.com/doi/10.1177/03331024241297652