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School Start Time and Migraine Frequency in Students

High school start time does not have a large effect on headache frequency in high school students with migraine, a new study found. The cross-sectional observational study included US high school students with migraine. Respondents attending schools starting at 8:30 AM were compared to those attending earlier start time schools. The primary outcome was headache days per month. Researchers found:

  • The analysis cohort included 256 students: 115 later group vs 141 earlier group.
  • Mean self-reported headache days per month were 7 (5) vs 8 (7), respectively, mean difference was ‒0.8 days.
  • Median self-reported total hours of sleep/school night were 5.6 vs 5.6.
  • Students attending later start time schools woke later and left home later.
  • Hours of sleep did not correlate with headache days per month.


Gelfand AA, Pavitt S, Greene K, et al. High school start time and migraine frequency in high school students. [Published online ahead of print April 24, 2019]. Headache. doi:10.1111/head.13535.


Pediatric migraine patients differ from adults in several ways. Both duration of migraine attacks and time to peak intensity tend to be shorter, headaches tend to be bilateral, and attacks can be resolved with vomiting or naps. Attacks can be linked positively or negatively to school cycles such as days of the week and summer breaks. Adolescents with migraine are often responsive to behavioral interventions, and prospective trials of preventive medications have for the most part been negative, while acute treatment studies have been plagued by high placebo rates requiring enrichment strategies. Because of the pediatric responsiveness to behavioral interventions, and in the hope that later start times might be associated with reduced migraine rates, these investigators evaluated onset of high school times and headache days per month and came up with high variance of negative results. The search for other simple interventions to reduce migraine frequency in adolescents goes on.

Stewart J. Tepper, MD, FAHS, Professor of Neurology, Geisel School of Medicine at Dartmouth, Director, Dartmouth Headache Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH