RESEARCH SUBMISSION

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

Amy A. Gelfand MD, MAS

Corresponding Author

Amy A. Gelfand MD, MAS

Child & Adolescent Headache Program, University of California, San Francisco, San Francisco, CA, USA

Correspondence

Amy A. Gelfand, Child & Adolescent Headache Program, University of California, San Francisco, 550 16th Street, 4th Floor, San Francisco, CA 94158, USA.

Email: [email protected]

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Sara Pavitt MD

Sara Pavitt MD

Child & Adolescent Headache Program, University of California, San Francisco, San Francisco, CA, USA

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Alexandra C. Ross PhD

Alexandra C. Ross PhD

Child & Adolescent Headache Program, University of California, San Francisco, San Francisco, CA, USA

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Christina L. Szperka MD

Christina L. Szperka MD

Division of Neurology, Children’s Hospital of Philadelphia & Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA

Division of Neurology, Children’s Hospital of Philadelphia & Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA

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Samantha L. Irwin MBBS

Samantha L. Irwin MBBS

Child & Adolescent Headache Program, University of California, San Francisco, San Francisco, CA, USA

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Suzanne Bertisch MD

Suzanne Bertisch MD

Division of Sleep and Circadian Disorders, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

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Katie L. Stone PhD

Katie L. Stone PhD

Department of Epidemiology & Biostatistics, University of California, San Francisco, San Francisco, CA, USA

Research Institute, California Pacific Medical Center, San Francisco, CA, USA

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Remi Frazier MS

Remi Frazier MS

Academic Research Systems, University of California, San Francisco, San Francisco, CA, USA

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Barbara Grimes PhD

Barbara Grimes PhD

Department of Epidemiology & Biostatistics, University of California, San Francisco, San Francisco, CA, USA

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I. Elaine Allen PhD

I. Elaine Allen PhD

Department of Epidemiology & Biostatistics, University of California, San Francisco, San Francisco, CA, USA

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First published: 25 November 2020
Citations: 8

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.

CONFLICT OF INTEREST

AAG has received consulting fees from Advanced Clinical, Biohaven, and Satsuma. She has received honoraria from UpToDate (for authorship) and JAMA Neurology (as an associate editor), and has received grant support from Amgen and the Duke Clinical Research Institute. Her spouse reports research support (to UCSF) from Genentech for a clinical trial, honoraria for editorial work from DynaMed Plus, and personal compensation for medical-legal consulting. SP and ACR have reported no conflicts of interest. CLS has consulted for Teva and Lundbeck and has received salary support from the NIH NINDS K23NS102521. SLI received honoraria for authoring a chapter for the Canadian Pharmacy Association (CPhA), compensation for consulting work with Impel NeuroPharma Inc., and research support from the Duke Clinical Research Institute. SB has received consulting fees from Merck, Dohme & Sharpe and Eisai, Inc. and has received grant support from Apnimed. KS has received grant support from Merck & Co. RF, BG, and IEA have reported no conflicts of interest.