The Impact of Shift Work on Migraine: A Case Series and Narrative Review

Abstract

Objective We present a case report of 2 migraine patients engaged in shift work, followed by a narrative review, to assess whether shift work influences headache‐related disability and chronification of migraine. Background Numerous modifiable factors can lead to chronification of migraine and to higher headache‐related disability. These include, among others, obesity, depression, overuse of acute medications, ineffective acute treatments, and stressful life events. Sleep disruptions and disorders are also felt to increase the risk of transitioning from episodic to chronic migraine. We hypothesize that shift work, which by definition leads to atypical or irregular sleep cycles, along with poor quality sleep, is a risk factor for chronification of migraine. Methods We present the case histories of 2 shift workers with migraine as per International Classification of Headache Disorders 3 criteria, seen at a large, busy academic headache center, followed by a narrative review of the literature. Results Previous literature regarding the relationship between shift work and migraine is sparse and conflicting, with more recent studies suggesting that shift work may be a risk factor for migraine‐related disability. In our case series, both patients initially reported severe migraine headache‐related disability and both patients had noted a worsening of their headaches after beginning night shift work. Both improved when switched back to day shifts, then worsened upon being put back on night shifts. Their headache patterns finally reverted from chronic to episodic migraine after eliminating night shifts completely and maintaining a good sleep routine. Conclusions In the 2 cases presented, shift work appeared to be associated with chronification of migraine and higher headache‐related disability despite optimal headache management and good patient adherence. A switch to only day shifts promoted transition to an episodic, less disabling pattern of migraine. It is clinically important to take a detailed sleep history in headache patients, and when appropriate, provide support for workplace accommodations. Further larger‐scale, rigorous studies are needed to more clearly delineate the relationship between shift work and migraine.

Identification of work accommodations and interventions associated with work productivity in adults with migraine: A scoping review

“…The question of job status was limited between semi-skilled worker versus university professor and laborer versus senior executive (30,36). A prospective study of two selected shift workers with chronic refractory migraine suggested an association between night shifts and work absences, but the sample size of two was too small to make definite conclusions (35).…”

Shift work and migraine: A systematic review

“…Interestingly, in a recent case series study, Sandoe et al described two‐shift workers with severe migraine headache‐related disability, who suffered a worsening of their headache after beginning night shift work. Both improved when switched back to day shifts, and worsened coming back on night shifts.…”

“…On the other side, it may be important to adopt workplace preventive measures for migraine patients and consider the opportunity for more severe, chronic migraineurs, to modify work schedules that should be periodically re-assessed according to the migraine course and its transition to more or less disabling patterns. 40 Overall, some limitations of the review need to be considered for a suitable interpretation of the results. The low number of reviewed studies and the not homogeneous methodological approaches adopted, in terms of analyzed outcomes (ie, migraine prevalence, incidence or risk), heterogeneous populations investigated (ie, national working populations, healthcare workers, nurses), and different sample size prevent a suitable comparison of the obtained findings.…”

“…From an occupational medicine perspective, it seems important to define suitable health promotion strategies to favor healthy lifestyles and to contrast the above‐mentioned migraine risk factors to support shift/night shift workers in tolerating such occupational organization according to a “global health” approach and possibly avoiding migraine manifestation. On the other side, it may be important to adopt workplace preventive measures for migraine patients and consider the opportunity for more severe, chronic migraineurs, to modify work schedules that should be periodically re‐assessed according to the migraine course and its transition to more or less disabling patterns …”

Subjective sleep quality and objective sleep physiology in migraineurs: a meta-analysis

“…given that previous studies report significant correlations between migraine-related disability and sleep disturbances 39 , and altering sleep (e.g. by switching back to day shifts from night shifts) can have a profound effect on migraine-related disability scores 40 . This may reflect the small number of studies and the high heterogeneity between them.…”