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While time\u2010of\u2010day and seasonal rhythmicity in migraine occurrence have been described, little is known about circalunar patterns. Understanding these rhythms may inform headache prediction and guide personalized preventive medication timing.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We performed a secondary, post\u2010hoc analysis using data from a prospective cohort study (March 2016\u2013October 2017). Participants completed twice\u2010daily electronic diaries, recording various characteristics including headache, and, when applicable, menstrual cycle timing. Participants wore wrist actigraphs for 6\u2009weeks. We tested for a 30\u2010day circalunar rhythm in headache risk at the population\u2010level. We then examined for lunar synchronized rhythms in individuals, adjusting our analysis for participant\u2010specific factors and differences in baseline headache risk. Sleep characteristics and menstrual timing were assessed as potential mediators of the relationship between lunar phase and headache occurrence.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Ninety\u2010eight participants were followed for a median length of 43\u2009days (interquartile range [IQR]: 42\u201345\u2009days) with an average of 24.2% (standard deviation [SD] 13.2) of those days being headache days. Population\u2010level analysis showed a significant relationship between lunar phase and headache risk (trough\u2010to\u2010peak odds ratio: 1.2 [95% confidence interval {CI}: 1.04, 1.49]). Individual\u2010level analysis, adjusted for age, sex\/menopausal status, and preventative medication use, showed 1.34 (95% CI: 1.1, 1.72) times higher headache odds at lunar cycle peak versus trough. Risk peaked 1\u20132\u2009days before new moon. Neither sleep characteristics nor menstrual timing appeared to mediate the lunar phase\u2010headache relationship.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Headache risk varied with the lunar cycle, with 34% higher odds shortly before new moon compared to before full moon. Sleep and menstrual cycle timing did not appear to explain this relationship, suggesting underlying chronobiological mechanisms. Additional studies are needed to confirm these findings and characterize individual variability in rhythmicity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Plain Language Summary<\/jats:title>\n                    <jats:p>\n                      <jats:boxed-text content-type=\"graphic\" position=\"anchor\">\n                        <jats:graphic xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" mimetype=\"image\/png\" position=\"anchor\" specific-use=\"enlarged-web-image\" xlink:href=\"graphic\/head15035-gra-0001-m.png\">\n                          <jats:alt-text>image<\/jats:alt-text>\n                        <\/jats:graphic>\n                      <\/jats:boxed-text>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/head.15035","type":"journal-article","created":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T09:42:28Z","timestamp":1756374148000},"page":"584-594","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Waning light, waxing pain: The lunar cycle's association with migraine headache occurrence"],"prefix":"10.1111","volume":"66","author":[{"given":"Alexander","family":"Yoo","sequence":"first","affiliation":[{"name":"Department of Medicine, Division of Sleep Medicine University of Pennsylvania Perelman School of Medicine  Philadelphia Pennsylvania USA"},{"name":"Department of Medicine, Center for Sleep and Circadian Neurobiology Institute for Biomedical Informatics, University of Pennsylvania Perelman School of Medicine  Philadelphia Pennsylvania USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brendan","family":"Keenan","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Sleep Medicine University of Pennsylvania Perelman School of Medicine  Philadelphia Pennsylvania USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5191-1475","authenticated-orcid":false,"given":"Angeliki","family":"Vgontzas","sequence":"additional","affiliation":[{"name":"Department of Neurology Brigham and Women's Hospital  Boston Massachusetts USA"},{"name":"Harvard Medical School  Boston Massachusetts USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Murray A.","family":"Mittleman","sequence":"additional","affiliation":[{"name":"Harvard Medical School  Boston Massachusetts USA"},{"name":"Department of Social and Behavioral Sciences Harvard T.H. 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