Q Why are attacks concentrated at night? Is it related to sleep?
A Hypothalamic activation during REM sleep stimulates the trigeminal nerve, so attacks cluster between midnight and dawn.
Detailed Answer
REM Sleep and Cluster Headache
Cluster headache attacks are strongly linked to the REM (rapid eye movement) stage of sleep. During REM sleep, the hypothalamus becomes highly active and is thought to over-stimulate the trigeminal nerve. For this reason, many patients experience a pattern of waking up around 90 minutes after falling asleep (the first REM phase).
Korean Medicine Clinic Perspective — Nighttime and Yin Energy
At Dongjedang, we regard the hours from midnight to dawn as the time when the Liver meridian (gangyeong) is most active (the chuk hour, roughly 1 to 3 a.m.). When Liver-Fire has accumulated, heat reaches its peak during these hours, and we interpret the resulting attacks accordingly. Improving sleep quality is an important pillar of treatment.
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