High School Start Time and Migraine Frequency in High School Students

Abstract

Objective.-To investigate whether later high school start time is associated with lower migraine frequency in high school students with migraine.Background.-Adequate sleep is thought to be important in managing adolescent migraine. The American Academy of Sleep Medicine recommends teenagers sleep ≥8 hours/night. Adolescents have a physiologically delayed sleep phase, going to bed, and waking later than children and adults. The American Academy of Pediatrics (AAP) accordingly recommends high schools start no earlier than 8:30 AM.Methods.-Cross-sectional observational study of U.S. high schoolers with migraine. Participants were recruited nationally using social media. Respondents attending high schools starting at 8:30 AM or later were compared to those attending earlier start time schools. The primary outcome was headache days/month.Results.-Two hundred and fifty-six subjects constituted the analysis set: 115 later group vs 141 earlier group. Age and sex did not differ. Mean (SD) self-reported headache days/month were 7 (5) vs 8 (7), respectively, (P = .985); mean difference (95% CI for the difference) was −0.8 (−2.3-0.7) days. Median (IQR) self-reported total hours of sleep/school night were: 5.6 (5.0-6.6) vs 5.6 (4.5-6.4), P = .058. Students attending later start time schools woke later (median [IQR] 6:38 AM [55 minutes] vs 6:09 AM [59 minutes], P < .0001) and left home later (median [IQR] 7:28 AM [28 minutes] vs 7:02 AM [60 minutes], P < .0001). Average commute time was also longer: 41 (21) minutes vs 28 (16), P < .0001. The vast majority in both groups reported missing breakfast at least once/week: 103/114 (90.4%) vs 128/141 (90.8%), P = .907. Hours of sleep did not correlate with headache days per month.Conclusion.-High school start time does not have a large effect on headache frequency in high schoolers with migraine. Given the high variance in headache days/month observed in this study, a larger study would be needed to determine whether there might still be a small effect of starting high school at/after 8:30 AM. More research is needed to establish evidencebased recommendations about lifestyle factors in adolescent migraine management.

Breakfast consumption is inversely associated with primary headaches in university students: The MEPHASOUS study

“…Based on our findings, we found that frequent breakfast consumption was inversely associated with the odds of primary headaches. In line with our findings, in a cross-sectional observational study in U.S. high schools, Gelfand et al reported that adolescences with migraine usually missed breakfast compared with healthy ones (35). In another cross-sectional study, it had been shown that headache was more prevalent among adolescences who consumed breakfast rarely (36).…”

Lifestyle Advice for Pediatric Migraine: Blaming the Patient, or Evidence Based?

“…51 High schoolers who attend schools that follow this recommendation may enjoy a slight decrease in migraine frequency compared with those whose high schools start before 8:30 AM, given that in the survey study self-reported headache frequency per month was 0.8 days lower in the later start time group, (95% CI for the difference À2.3 to 0.7), but this was not statistically significant. 30 Interestingly, adolescent headache-related emergency department visits are more frequent in the months of September and January relative to summertime, but are not higher during any of the other school-year months. 52 September and January represent the two times of year that adolescents transition back from relatively longer vacations, that is, times during which they may have been able to sleep on their own physiologic schedule, and return back to a more society-driven schedule.…”

“…However, in the U.S. survey study of high schoolers with migraine, total hours of sleep did not correlate with selfreported headache days per month. 30 Furthermore, sleeping for at least 8 hours per night did not have a significant effect on migraine frequency. That said, the median total hour of sleep self-reported by these adolescents was less than 6 hours per night, with only one in eight respondents getting at least 8 hours of sleep per night.…”

“…The average number of missed breakfasts was 3 out of a 5-day school week. 30 Those who skipped breakfast at least once a week did not have a higher (self-reported) migraine frequency than those who did not. In fact, the observed effect was in the opposite direction, although the finding was not statistically significant (estimated effect of breakfast skipping on headache days per month: À1.5 days; 95% CI: À4.0 to 1.1).…”

“…In fact, the observed effect was in the opposite direction, although the finding was not statistically significant (estimated effect of breakfast skipping on headache days per month: À1.5 days; 95% CI: À4.0 to 1.1). 30 In the "Adequate Hydration" section where adolescents were asked to self-report how much water they drank, adolescents "on average reported skipping one meal per week despite recommendations of consistently eating three meals per day." 8 Hence, it seems clear that many adolescents with migraine sometimes skip meals.…”