Later School Start Times, Extended Sleep Linked With Lower Migraine Frequency in Teens

Teens with migraines attending high schools starting before 8:30 am were found to experience an average 7.7 headache days per month, nearly 3 more headache days than those with later school start times, according to study findings published today in Headache: The Journal of Head and Face Pain.

While the American Academy of Sleep Medicine suggests that middle and high schools start no earlier than 8:30 am, the CDC finds that only 18% of these institutions adhere to this recommendation. This could prove detrimental to adolescents and teens whose sleep-wake cycle tends to follow late-to-bed, late-to-rise habits.

Recent research has shown that insufficient sleep is linked with impaired behavioral and social well-being, which were shown to affect school performance as well as physical and mental health. In addition to these concerns, lead study author Amy Gelfand, MD, neurologist at the Pediatric Headache Program at University of California, San Francisco Benioff Children's Hospitals, noted in a statement that sleep hygiene may affect migraine incidence as evidence suggests a relationship between these 2 factors.

"Getting adequate sleep and maintaining a regular sleep schedule may reduce the frequency of migraines," said Gelfand.

Seeking to better understand what impact school start times may have on migraine frequency, researchers reached out to high school students via social media to complete a brief survey, in exchange for a $10 gift card. The study cohort (N = 1012) included students from grades 9 to 12 whose headaches fit the criteria for migraine, in which students of schools starting before (n = 509) and after (n = 503) 8:30 am were compared.

In assessing both groups, each had an average 24-minute commute to school. Students of the earlier-start group were shown to wake up at 6:25 am and begin school at 7:56 am, whereas the later-start group woke up at 7:11 am and began school at 8:43 am. Notably, researchers reported that the later-start group went to bed earlier on school nights than the earlier-start group (average: 10:19 pm versus 10:58 pm).

After adjusting for risk factors, including inadequate sleep, skipping breakfast, gender, grade, homework volume, and migraine medication use, the difference in the average number of headache days per month narrowed from 7.7 days for the earlier-start group and 4.8 days for the later-start group (P < .001) to 7.1 and 5.8 days respectively (P < .001). However, Gelfand highlights that the 1.3 day difference between the 2 groups remains significant and comparable to that seen in studies of migraine prevention drugs.

"If our findings are confirmed in future research, shifting to a later high school start time is a modifiable, society-level intervention that could translate to thousands of fewer migraine days and fewer missed days of school for teenagers," said Gelfand who also noted the opportunity presented by the coronavirus disease 2019 pandemic to make changes to school start times that can be carried over once in-person classes resume.

Reference

Gelfand A, Allen IE, Pavitt S, et al. Later high school start time is associated with lower migraine frequency in adolescents. Headache. Published online November 25, 2020. doi:10.1111/head.14016