Study Identifies Predictors of Migraine Onset by Time of Day


By: By: Elizabeth Obigwe. Freelance Writer, with medical review and editorial support by the DLHA Team


Migraine is one of the most common types of primary headaches that have been of great interest to researchers over the years. Previous studies have shown that sleep disorders and stress are often associated with migraine attacks. However, it was only recently that researchers made a more nuanced finding on how these factors may help predict migraine onset.


The study which involved  477 people (61% female) ages 7 to 84 required participants to self-rate their mood, energy, stress, and headaches four times a day for two weeks. They also had to rate their sleep quality once a day, and they equally wore sleep and physical activity monitors.


What Are The Predictors of Morning Migraine?


Poor perceived quality of sleep, lower sleep quality and low energy level on the previous day all increased the likelihood of a migraine attack in the morning.


The study found that poorer perceived sleep quality led to a 22% increased chance of a headache attack the next morning. Similarly, a decrease in the self-reported usual quality of sleep increased the chance of a headache attack in the morning by 18%. Also, a decrease in the usual energy level on the previous day was associated with a 16% increase in the likelihood of a migraine attack the next morning. 


One of the study authors, Kathleen R. Merikangas, PhD, of the National Institute of Mental Health, part of the National Institutes of Health in Bethesda, Maryland pointed out “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.”


What Are The Predictors Of Later Day Migraine?


In the afternoon and evening, the risk of headaches was increased by high stress levels or having an energy higher than usual the day before. Both factors were associated with a 17% increased chance of a headache attack the following afternoon or evening.


Although anxiety and depression are known to be associated with migraine, this study did not find the symptoms of these disorders as predictors of migraine. 


“Surprisingly, we found no link between a person’s anxiety and depression symptoms and their likelihood of having a migraine attack the next day,” Merikangas said


Limitations of the study


Although the study presents some interesting insights into the predictors of migraine by time of day, it has several limitations for general applicability. Among these are:

a) Small study population limited to a specific North American community

b) Short study duration, and

c) Self-rating bias


More research is needed to validate the current research finding and its potential for global application to the care of migraine sufferers.


Final Words


“The use of 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.” said one of the authors Tarannum M. Lateef, MD, of the Children’s National Health System in Washington, D.C.

This is in line with the conclusion of Uluduz et al. in their study on “Sleep Changes During Prophylactic Treatment of Migraine.” The authors stated that studying routine objective sleep measures such as sleep quality will help clarify the nature of sleep disturbances connected to primary headaches, thereby improving headache treatment.



1. American Academy of Neurology. Can we predict when a migraine attack will occur? [Internet. 2024]. [cited 2024 Feb 3]. Available from: 

2. Lateef TM, Dey D, Leroux A, Cui L, Xiao M,  Zipunnikov V, and Merikangas KR.  Association Between Electronic Diary–Rated Sleep, Mood, Energy, and Stress With Incident Headache in a Community-Based Sample. Neurology. 2024. February 27, 102 (4). Abstract. Available from:

3. Uluduz D, Seydaoglu G, Okuyucu E, Melek I, Duman T, Dede O. Sleep changes during prophylactic treatment of Migraine. Annals of Indian Academy of Neurology. 2015;18(3):298. doi:10.4103/0972-2327.160084 Available from:



Published: February 6, 2024

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