Evening Chronotype Tied to Poor Health, Headache Disability in Migraine

Patients with migraine who identify as evening chronotypes experience greater headache-related disability and worse overall physical and mental health than their morning-type counterparts, according to study results published in the Journal of Sleep Research.

Chronotype, an individual’s natural tendency to feel more alert in the morning or evening, has previously been associated with mental health vulnerabilities. In this observational study, researchers examined the relationship between chronotype and health status in a cohort of 360,081 adults from the UK Biobank, 5.6% of whom had a formal diagnosis of migraine based on International Classification of Diseases-10 codes.

Chronotype was assessed via self-report and categorized into “morning” or “evening” types. Participants were grouped as either control individuals or patients with migraine by chronotype: morning-type control individuals (n=210,775), evening-type control individuals (n=129,174), morning-type patients with migraine (n=12,194), and evening-type patients with migraine (n=7938).

Across all variables assessed, including neuroticism, depressive symptoms, stress exposure, body fat percentage, and self-rated overall health, those in the evening-type migraine group (M_evening) consistently showed the poorest scores. Mean neuroticism scores were highest in M_evening individuals (6.0) and lowest in morning-type control individuals (4.8). M_evening participants had also had significantly higher current depression symptoms (6.66), and recent life stress (18.9%).

Body composition findings also reflected greater vulnerability in the M_evening group. Their average body fat percentage was 34.5%, compared with 31.8% in morning-type control individuals. Overall health ratings were significantly lower among evening-type patients with migraine, with only 9.8% describing their health as “excellent,” compared to 16.5% of morning-type control individuals.

To further explore migraine-related impact, the researchers analyzed a subsample of 15,356 participants with self-reported, questionnaire-validated migraine. Despite similar pain characteristics across chronotypes, evening-type individuals (n=6384) reported significantly greater functional impairment from their headaches compared to their morning-type counterparts (n=8972). Headache-related disability scores averaged 4.49 in the evening group vs 3.87 in the morning group (P <.001).

The M_evening group also experienced a slightly higher frequency of unilateral headache pain and reported more frequent attacks. However, many symptom domains, including aura, photophobia, and pulsating pain, showed no significant differences.

The evening chronotype was more common in patients with migraine than in non-migraine control individuals (39.4% vs 38%), suggesting a modest but significant association (odds ratio, 1.06; 95% CI, 1.03-1.09; P <.001).

Study limitations included its cross-sectional design and reliance on self-reported chronotype classification.

“…[A]ll our results suggest that evening chronotype is a risk factor for adverse mental and physical health symptoms among migraine patients,” the researchers concluded.

This research was supported by the New National Excellence Program of the Ministry for Culture and Innovation, the Hungarian National Research, Development, and Innovation Office, the Ministry of Innovation and Technology of Hungary, the Thematic Excellence Programme (Tématerületi Kiválósági Program) of the Ministry for Innovation and Technology in Hungary, the Hungarian Brain Research Program, the Hungarian Academy of Sciences, and the Doctoral School of Pharmaceutical Sciences, Semmelweis University, Hungary.