High School Start Time Has Little Effect on Teen Migraine Frequency

high school students walking
Teens are getting less than the recommended 8 hours of sleep per day, yet researchers were unable to find a correlation between migraine and insufficient sleep in teens with migraines.

High school start time does not have a large effect on headache frequency in high schoolers with migraine, according to a study recently published in Headache.

Researchers of previous studies have found that there is a significant connection between sleep and migraine across all ages. Furthermore, teens struggle to get the 8 or more hours of sleep recommended by pediatricians because early school start times conflict with their physiologically delayed sleep phases. While the American Academy of Pediatrics recommends that middle schools and high schools start no earlier than 8:30 am, only about 18% of high schools in the United States comply. Investigators hypothesized that students with migraine at schools that comply with that recommendation would have lower migraine frequency compared with those at schools that start earlier. This cross-sectional, observational study recruited students from high schools with a consistent start time using social media. Participants had to live in the United States and be able to read English. To determine migraine status, investigators asked 4 questions to approximate ICHD-3 criteria for migraine in adolescents. Eligibility was dependent on a “Yes” response to each. The primary outcome was headache days per month.

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The analysis set included 256 individuals: 115 in the later group (start after 8:30 am) vs 141 in the earlier group (start before 8:30 am). There was wide variability within the groups, but on average, participants in the later group had fewer headache days per month (7 vs 8). However, this difference was not statistically significant (P =.985). The mean difference in headache days between groups was -0.8 (95% CI, -2.3 to 0.7). The proportion of students taking migraine preventatives and the number of days of acute headache medication use were similar in both groups. Median total hours of sleep were 5.6 (interquartile range [IQR], 5.0-6.6) in the late start group vs 5.6 (IQR, 4.5-6.4) in the early start group, P =.058. Surprisingly, headache days per month did not correlate with total hours of sleep. Exploratory post hoc analyses showed that results did not differ among those with <15 headache days per month vs those with ≥15 headache days per month, those who were in lower grades (9th and 10th) vs those in higher grades (11th and 12th), or girls vs boys. 

Limitations to this study include self-reported and recall-based data, a lack of clinician-confirmed migraine status, participants with higher than average headache days, and a smaller than expected effect size paired with larger variance.

Although the researchers of the study concluded that the study did not establish a statistically significant correlation between high school start time and headache days per month, it did importantly show that high schoolers with migraine get insufficient sleep. Further research is necessary to determine appropriate lifestyle recommendations for migraine management in teens to strengthen the doctor-patient relationship, achieve better migraine control, and avoid alienating teenagers.

Multiple authors report associations with the pharmaceutical industry. Please see original reference for a full list of authors’ disclosures.


Gelfand AA, Pavitt S, Greene K, et al. High School Start Time and Migraine Frequency in High School Students [published online April 24, 2019]. Headache. doi: 10.1111/head.13535