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

Amy A Gelfand; Sara Pavitt; Alexandra C Ross; Christina L Szperka; Samantha L Irwin; Suzanne Bertisch; Katie L Stone; Remi Frazier; Barbara Grimes; I Elaine Allen

doi:10.1111/head.14016

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

Headache. 2021 Feb;61(2):343-350. doi: 10.1111/head.14016. Epub 2020 Nov 25.

Authors

Amy A Gelfand¹, Sara Pavitt¹, Alexandra C Ross¹, Christina L Szperka^{2

3}, Samantha L Irwin¹, Suzanne Bertisch⁴, Katie L Stone^{5

6}, Remi Frazier⁷, Barbara Grimes⁵, I Elaine Allen⁵

Affiliations

¹ Child & Adolescent Headache Program, University of California, San Francisco, San Francisco, CA, USA.
² Division of Neurology, Children's Hospital of Philadelphia & Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
³ Division of Neurology, Children's Hospital of Philadelphia & Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
⁴ Division of Sleep and Circadian Disorders, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
⁵ Department of Epidemiology & Biostatistics, University of California, San Francisco, San Francisco, CA, USA.
⁶ Research Institute, California Pacific Medical Center, San Francisco, CA, USA.
⁷ Academic Research Systems, University of California, San Francisco, San Francisco, CA, USA.

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.

Keywords: adolescent; migraine; sleep.

MeSH terms

Adolescent
Adult
Cross-Sectional Studies
Female
Health Surveys
Humans
Male
Migraine Disorders / epidemiology*
Schools / statistics & numerical data*
Self Report
Students / statistics & numerical data*
Time Factors
United States / epidemiology
Young Adult

Abstract

MeSH terms

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