Later beginning faculty in reference to a decreased frequency of migraines in adolescents

Students with migraines report a lower frequency of headache when their school starts at 8:30 a.m. or later. This is a recommended start time by the American Academy of Pediatrics, compared to having a headache at school earlier in the day.

Previous data have supported a relationship between sleep and headache. Additional data showed that around 8% to 12% of teenagers experience migraines, the episodes of which often result in missed school days. The researchers in the study tried to assess whether back to school was related to the frequency of adolescent headaches.

To do this, they conducted a large cross-sectional study that polled 1,012 high schoolers with migraines in the United States. After being recruited via social media, participants completed the survey online. The study researchers compared the primary result, self-reported headache days per month, of respondents who stated that they went to school before 8:30 a.m. (early group; n = 509) with respondents who stated that they were at 8:30 a.m. or going to school later (late group); n = 503).

At baseline, the average self-reported headache day per month was 7.7 (standard deviation) [SD], 6.1) in the early start group and 4.8 (SD, 4.6) in the late start group (mean difference, 2.9; 95% CI, 2.2-3.6; P <.001). The respondents from the late group reported an average of 7.9 hours of sleep on a school night, compared to those from the early group who reported 6.9 hours of sleep (P <0.001).

In an analysis that took into account total hours of sleep, gender, migraine prevention, days of acute drug use, hours of homework, grade level, and lack of breakfast, respondents in the late group still showed lower average self-reported headache days per month than in the early group (5.8 [95% CI, 5.3–6.2] vs 7.1 [95% CI, 6.7-7.4], respectively; mean difference -1.3; 95% CI, -1.9 to -0.7; P <0.001).

Limitations of this study included reliance on self-reported data, the lack of confirmation from the clinician for migraine cases in the surveyed population, and the lack of validation for survey questions using the gold standard of a clinic interview.

The study’s researchers concluded that postponing school start times later in the morning, when results are validated in future research, “could result in thousands of fewer headache days and missed school days in adolescents annually”.


Gelfand AA, Pavitt S., Ross AC, et al. The later start of school is associated with a lower frequency of migraines in young people. A headache. Published online November 25, 2020. doi: 10.1111 / head.14016

This article originally appeared on Clinical Pain Advisor

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