Woldeamanuel Yohannes W, Rahman Ariana, Hyimanot Esam T, Chirravuri Richa, Fani Mahya, Javaheri Elika D, Welch Madeline, Zhuang Joyce, Mun Chung Jung
Department of Neurology, Mayo Clinic Arizona & Arizona State University.
Arizona State University, undergraduate trainee.
medRxiv. 2025 Aug 1:2025.07.31.25332540. doi: 10.1101/2025.07.31.25332540.
Migraine is linked to circadian rhythm disruptions, with morning attack peaks, circadian variations in trigeminal pain sensitivity, anterior hypothalamus involvement, and core circadian clock gene activity. Irregular night shift work, affecting up to 50% of the population, including new parents and students, causes significant circadian disruption. We hypothesize that irregular night shifts increase migraine prevalence compared to fixed schedules.
A systematic review and meta-analysis of observational studies up to March 27, 2025, assessed migraine prevalence in irregular versus fixed night shift workers, searching Web of Science and PubMed with terms like "shift work" and "migraine" (PRISMA/MOOSE-compliant, PROSPERO: CRD420250654865). Study quality was evaluated using the Newcastle-Ottawa Scale (NOS). A random-effects meta-analysis calculated weighted odds ratios (ORs) for migraine prevalence.
From 203 records, 13 high-quality cross-sectional studies (N=38,798,271, 77% female, NOS 9-10) showed irregular night shifts significantly increased migraine odds (OR=1.61, 95% CI: 1.27-2.04, p<0.0001, I=73%), with females at higher odds (OR=2.02-4.21). Meta-regression linked higher female representation to increased migraine odds (β=0.70, p=0.0003, R=50%). Irregular night shifts showed no association with tension-type headache (OR=0.79, 95% CI: 0.43-1.45).
Irregular night shifts disrupt circadian rhythms, elevating migraine odds but not tension-type headache, suggesting fixed schedules may reduce the burden. Chronobiology-informed management, including slow-rotating schedules (≥5 days with rest days), delay-directed rotations, timed light exposure, and ambient temperature regulation, needs testing to prevent 'Shift Work Migraine Disorder,' a proposed distinct migraine subgroup.
偏头痛与昼夜节律紊乱有关，存在早晨发作高峰、三叉神经痛敏感性的昼夜变化、下丘脑前部受累以及核心昼夜节律基因活动。影响多达50%人群（包括新父母和学生）的不规律夜班工作会导致显著的昼夜节律紊乱。我们假设，与固定排班相比，不规律夜班工作会增加偏头痛患病率。
截至2025年3月27日对观察性研究进行系统综述和荟萃分析，评估不规律与固定夜班工作者的偏头痛患病率，使用“轮班工作”和“偏头痛”等术语在科学网和PubMed上检索（符合PRISMA/MOOSE标准，PROSPERO：CRD420250654865）。使用纽卡斯尔-渥太华量表（NOS）评估研究质量。随机效应荟萃分析计算偏头痛患病率的加权比值比（OR）。
从203条记录中，13项高质量横断面研究（N = 38,798,271，77%为女性，NOS 9 - 10）显示不规律夜班工作显著增加偏头痛几率（OR = 1.61，95%可信区间：1.27 - 2.04，p < 0.0001，I² = 73%），女性几率更高（OR = 2.02 - 4.21）。荟萃回归将女性比例较高与偏头痛几率增加联系起来（β = 0.70，p = 0.0003，R² = 50%）。不规律夜班工作与紧张型头痛无关联（OR = 0.79，95%可信区间：0.43 - 1.45）。
不规律夜班工作会扰乱昼夜节律，增加偏头痛几率但不增加紧张型头痛几率，表明固定排班可能减轻负担。需要对基于时间生物学的管理方法进行测试，包括缓慢轮换排班（≥5天并安排休息日）、延迟定向轮换、定时光照暴露和环境温度调节，以预防“轮班工作性偏头痛障碍”，这是一种新提出的独特偏头痛亚组。
