Department of Neurology, University of California, San Francisco, San Francisco, CA, USA.
Department of Neurology, Stanford University Hospital and Clinics, Palo Alto, CA, USA.
Headache. 2019 Jul;59(7):1024-1031. doi: 10.1111/head.13535. Epub 2019 Apr 24.
To investigate whether later high school start time is associated with lower migraine frequency in high school students with migraine.
Adequate sleep is thought to be important in managing adolescent migraine. The American Academy of Sleep Medicine recommends teenagers sleep ≥8 hours/night. Adolescents have a physiologically delayed sleep phase, going to bed, and waking later than children and adults. The American Academy of Pediatrics (AAP) accordingly recommends high schools start no earlier than 8:30 AM.
Cross-sectional observational study of U.S. high schoolers with migraine. Participants were recruited nationally using social media. Respondents attending high schools starting at 8:30 AM or later were compared to those attending earlier start time schools. The primary outcome was headache days/month.
Two hundred and fifty-six subjects constituted the analysis set: 115 later group vs 141 earlier group. Age and sex did not differ. Mean (SD) self-reported headache days/month were 7 (5) vs 8 (7), respectively, (P = .985); mean difference (95% CI for the difference) was -0.8 (-2.3-0.7) days. Median (IQR) self-reported total hours of sleep/school night were: 5.6 (5.0-6.6) vs 5.6 (4.5-6.4), P = .058. Students attending later start time schools woke later (median [IQR] 6:38 AM [55 minutes] vs 6:09 AM [59 minutes], P < .0001) and left home later (median [IQR] 7:28 AM [28 minutes] vs 7:02 AM [60 minutes], P < .0001). Average commute time was also longer: 41 (21) minutes vs 28 (16), P < .0001. The vast majority in both groups reported missing breakfast at least once/week: 103/114 (90.4%) vs 128/141 (90.8%), P = .907. Hours of sleep did not correlate with headache days per month.
High school start time does not have a large effect on headache frequency in high schoolers with migraine. Given the high variance in headache days/month observed in this study, a larger study would be needed to determine whether there might still be a small effect of starting high school at/after 8:30 AM. More research is needed to establish evidence-based recommendations about lifestyle factors in adolescent migraine management.
研究高中生偏头痛患者中，较晚的高中开始时间是否与偏头痛发作频率较低有关。
充足的睡眠被认为对青少年偏头痛的管理很重要。美国睡眠医学学会建议青少年每晚睡眠≥8 小时。青少年的生理睡眠阶段较晚，入睡和醒来的时间晚于儿童和成人。因此，美国儿科学会（AAP）建议高中不要早于 8：30 上课。
对美国偏头痛高中生进行横断面观察性研究。使用社交媒体在全国范围内招募参与者。将参加 8：30 或更晚开始上课的高中的学生与参加较早开始上课的学校的学生进行比较。主要结局指标是头痛天数/月。
共有 256 名受试者纳入分析集：115 名晚组和 141 名早组。年龄和性别无差异。自我报告的头痛天数/月分别为 7（5）天和 8（7）天（P=0.985）；平均差值（差值的 95%CI）为-0.8（-2.3 至 0.7）天。自我报告的平均（IQR）在校每夜睡眠时间分别为：5.6（5.0-6.6）小时和 5.6（4.5-6.4）小时（P=0.058）。参加较晚开始上课的学校的学生起床较晚（中位数[IQR]6：38 上午[55 分钟]比 6：09 上午[59 分钟]，P<0.0001），离家较晚（中位数[IQR]7：28 上午[28 分钟]比 7：02 上午[60 分钟]，P<0.0001）。平均通勤时间也更长：41（21）分钟比 28（16）分钟，P<0.0001。两组绝大多数学生每周至少错过一次早餐：114 名中有 103 名（90.4%）和 141 名中有 128 名（90.8%）（P=0.907）。睡眠时间与每月头痛天数无关。
高中开始时间对偏头痛高中生的头痛频率没有很大影响。鉴于本研究中观察到的每月头痛天数变化很大，需要更大的研究来确定 8：30 点或之后开始上学会否仍有较小的影响。需要进一步研究以确定青少年偏头痛管理中生活方式因素的循证建议。
