A recent study used a mobile app to more accurately predict when a migraine will occur – and help stave off attacks – by tracking sleep, energy, emotions and stress patterns, and finding, among other factors, that low energy levels the previous day could be linked to headache the next morning.
Migraine was often under-diagnosed and under-treated, and it could be difficult to find strategies to prevent attacks, said the researchers.
Their study, published in Neurology, the medical journal of the American Academy of Neurology, found that poor perceived sleep quality as well as a lower than usual quality of sleep on the preceding night were both associated with an increased risk of a migraine the next morning.
A lower than usual energy level the previous day was also linked to headache the next morning – but these factors did not lead to an increased risk of migraine in the afternoon or evening, reports News-Medical.net.
The only predictors of an afternoon or evening headache were increased stress levels or having higher-than-average energy the day before.
The study involved 477 people aged seven to 84, and included 291 females. Through a mobile app, participants were asked to rate their mood, energy, stress and headaches four times a day for two weeks.
They also rated their sleep quality once a day and wore sleep and physical activity monitors. Nearly half of them had a history of migraine and 59% had at least one morning headache attack during the study.
People with poorer perceived sleep quality on average had a 22% increased chance of a headache attack the next morning.
A decrease in the self-reported usual quality of sleep was also associated with an 18% increased chance of a headache attack the next morning.
Likewise, a decrease in the usual level of energy on the prior day was associated with a 16% greater chance of headache the next morning.
In contrast, greater average levels of stress and substantially higher energy than usual the day before was associated with a 17% increased chance of headache on the next afternoon or evening.
After considering sleep, energy and stress, neither anxious nor depressed mood was associated with headache attacks.
“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,” said Kathleen Merikangas, PhD, study author, from the National Institute of Mental Health in Maryland.
“Perhaps most interesting, headaches were associated with self-rated sleep quality rather than actual measures of sleep patterns. This highlights the importance of perceived physical and emotional states in the underlying causes of migraine.
“These different patterns of predictors of morning and later-day headaches highlight the role of the circadian rhythms in headache. The findings may give us insight into the processes underlying migraine and help us improve treatment and prevention.”
“The findings demonstrate the importance of monitoring sleep changes as a predictor of headache attacks,” said study author Dr Tarannum Lateef of the Children’s National Health System in Washington.
“Using apps that track sleep and other health, behavioural and emotional states in real time can provide valuable information that can help us to manage migraine.”
A limitation of the study is that participants were tracked over a short period.
Study details
Association between electronic diary–rated sleep, mood, energy, and stress with incident headache in a community-based sample
Tarannum Lateef, Debangan Dey, Andrew Leroux, Lihong Cui, Mike Xiao, Vadim Zipunniko , and Kathleen. Merikangas.
Published in Neurology on 24 January 2024
Abstract
Background and Objectives
The aim of this study was to examine the diurnal links between average and changes in average levels of prospectively rated mood, sleep, energy, and stress as predictors of incident headache in a community-based sample.
Methods
This observational study included structured clinical diagnostic assessment of both headache syndromes and mental disorders and electronic diaries that were administered four times per day for two weeks yielding a total of 4 974 assessments. The chief outcomes were incident morning (am) and later-day (pm) headaches. Generalised linear mixed-effects models were used to evaluate the average and lagged values of predictors including subjectively rated mood, anxiety, energy, stress, and sleep quality and objectively measured sleep duration and efficiency on incident am and pm headaches.
Results
The sample included 477 participants (61% female), aged 7 through 84 years. After adjusting for demographic and clinical covariates and emotional states, incident am headache was associated with lower average (ß = −0.206*; confidence intervals: −0.397 to −0.017) and a decrease in average sleep quality on the prior day (ß = −0.172*; confidence interval: −0.305, −0.039). Average stress and changes in subjective energy levels on the prior day were associated with incident headaches but with different valence for am (decrease) (ß = −0.145* confidence interval: −0.286, −0.005) and pm (increase) (ß = 0.157*; confidence interval: 0.032, 0.281) headache. Mood and anxiety disorders were not significantly associated with incident headache after controlling for history of a diagnosis of migraine.
Discussion
Both persistent and acute changes in arousal states manifest by subjective sleep quality and energy are salient precursors of incident headaches. Whereas poorer sleep quality and decreased energy on the prior day were associated with incident morning headache, an increase in energy and greater average stress were associated with headache onsets later in the day. Different patterns of predictors of morning and later-day incident headache highlight the role of circadian rhythms in the manifestations of headache. These findings may provide insight into the pathophysiologic processes underlying migraine and inform clinical intervention and prevention. Tracking these systems in real time with mobile technology provides a valuable ancillary tool to traditional clinical assessments.
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