Later high school start time is associated with lower migraine frequency in adolescents

Abstract

Objective: To determine whether high school start time is associated with headache frequency in adolescents with migraine. Background: Adolescence is marked by a physiologic delayed circadian phase, characterized by later bedtimes and wake times. The American Academy of Pediatrics (AAP) recommends that high schools start no earlier than 8:30 a.m., but most high schools in the United States start earlier. The study hypothesis was that adolescents with migraine whose high schools start at 8:30 a.m. or later (late group) would have lower headache frequency than those whose schools start earlier than 8:30 a.m. (early group). Methods: This was a cross-sectional Internet survey study of US high schoolers with migraine recruited online through social media. Comparisons were made between the late group and the early group. The primary outcome measure was self-reported headache days/month. Results: In total, 1012 respondents constituted the analytic set: n = 503 in the late group versus n = 509 in the early group. Mean (SD) self-reported headache days/month was 4.8 (4.6) versus 7.7 (6.1) in the late and early groups, respectively (p < 0.001); mean difference −2.9 (95% CI −2.2 to −3.6). Mean (SD) self-reported hours of sleep on a school night was 7.9 (0.9) versus 6.9 (1.3), p < 0.001. Adjusting for total hours of sleep, sex, taking a migraine preventive, days of acute medication use, hours of homework, grade level, and missing breakfast, mean (SD) self-reported headache days/ month remained lower in the late group than in the early group: 5.8 (95% CI 5.3-6.2) versus 7.1 (95% CI 6.7-7.4), (p < 0.001); mean difference −1.3 (95% CI −1.9 to −0.7). Conclusion: Adolescents with migraine who attend high schools that follow AAP recommendations for start times have lower self-reported headache frequency than those whose high schools start before 8:30 a.m. If prospective studies confirm this finding, shifting to a later high school start time may be an effective strategy for migraine prevention in adolescents.

Headache in Children and Adolescents

“…95 Changing these behaviors is practical, and consistent education about lifestyle habits may have acted as an effective cointervention in at least one migraine preventive trial. 96 However, factors outside the child's control may preclude change, including school start time, 97 homework, and work schedules of parent(s)/guardian(s). Even when children intend to follow the advice, adherence is difficult.…”

Headache in Children and Adolescents

“…Generally, recommendations should focus on areas where there is some evidence to support a link between headaches and the lifestyle factor. Poor sleep 140 and early wake times 141 have been associated with headaches in children and adolescents, and education around sleep hygiene is likely helpful in this population. Where there is comorbid insomnia, there is preliminary evidence to support the use of cognitive behavioral therapy for insomnia in adolescents with chronic migraine 142 .…”

From diet to disasters, lifestyle factors can affect headaches and migraine

“…Achieving adequate sleep in teenagers can be cumbersome, for their circadian phase delays as they develop. One cross‐sectional survey found that adolescents in high schools with start times after 8:30 a.m. reported lower frequencies of headache than those in schools that started at an earlier time 12 …”

“…One cross-sectional survey found that adolescents in high schools with start times after 8:30 a.m. reported lower frequencies of headache than those in schools that started at an earlier time. 12 Headaches can also be related to life events like major childhood experiences and natural disasters or calamities (such as a global pandemic). Childhood maltreatment has previously been associated with an increased likelihood of developing migraine.…”