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• Posted January 25, 2024

What Factors Really Predict Migraine Onset?

Factors like sleep, energy levels and stress can predict the onset of a migraine headache, a new study finds.

Those factors differed from the morning to the afternoon and evening, however.

Poor perceived sleep quality, lower-than-usual quality of sleep and lower-than-usual energy levels are associated with a morning migraine, according to the report published online Jan. 24 in the journal Neurology.

Conversely, afternoon and evening migraines are tied to increased stress levels or higher-than-usual energy levels the day before.

"These different patterns of predictors of morning and later-day headaches highlight the role of the circadian rhythms in headache,"said study author Kathleen Merikangas, chief of the Genetic Epidemiology Research Branch of the National Institute of Mental Health (NIMH). "The findings may give us insight into the processes underlying migraine and help us improve treatment and prevention."

For the study, researchers tracked potential predictors of a migraine among 477 people ages 7 through 84.

Nearly half the participants had a history of migraines, and about three out of five had at least one morning migraine during the study.

The participants rated their mood, energy, stress and headaches four times a day for two weeks, using a mobile app. They also rated their sleep quality once a day, and wore activity monitors to track their sleep and physical activity.

Results showed that poor perceived sleep quality came with a 22% increased risk of a morning migraine, while a decrease in self-reported quality of sleep was associated with an 18% increased risk.

But what mattered most was how you perceived your prior night's sleep.

"Headaches were associated with self-rated sleep quality rather than actual measures of sleep patterns,"Merikangas noted in a NIMH news release. "This highlights the importance of perceived physical and emotional states in the underlying causes of migraine."

A decrease in usual energy levels the prior day was also linked to a 16% increased risk of a migraine in the morning.

On the other hand, greater stress levels and substantially higher energy levels the day before were associated with a 17% increased risk of migraine in the afternoon or evening.

Neither anxiety nor depression levels were linked to migraine risk, after taking into account sleep, energy and stress, researchers noted.

"Surprisingly, we found no link between a person's anxiety and depression symptoms -- either having more symptoms or having higher-than-average levels of symptoms -- and their likelihood of having a migraine attack the next day,"Merikangas said.

"Our study demonstrates the importance of monitoring sleep changes as a predictor of headache attacks,"said researcher Dr. Tarannum Lateef, a pediatric neurologist with the Children's National Health System in Washington, D.C. "The use of apps that track sleep and other health, behavioral and emotional states in real time can provide valuable information that can help us to manage migraine."

More information

The National Institutes of Health have more about migraine.

SOURCE: American Academy of Neurology, news release, Jan. 24, 2024