How Later High School Start Times Helps Teens with Migraine

A new study shows later high school starts times mean fewer migraine days for teens with migraine

A new study confirms what parents, teachers and high school seniors have suspected for years: A later school start time means fewer headache days.

A study recently published in Headache: The Journal of Head and Face Pain found that teens with migraine had fewer headache days if they attended a school that started no earlier than 8:30 a.m.

We spoke to Dr. Amy A. Gelfand,  Director of Pediatric Headache at UCSF and one of the study’s authors, to learn more about the study and how parents can advocate for their children with migraine.

Why Study High School Start Times?

Dr. Gelfand notes that studying migraine preventive medications in children and adolescents has been challenging because of high placebo response rates. “I think it’s opened up greater interest in finding non-pharmacologic treatment strategies for decreasing migraine frequency in young people,” she says.

As children enter adolescence, their natural sleep-wake cycle moves to later hours. Often, teenagers have a hard time falling asleep before 11 p.m., but they still need at least eight hours of sleep. Because of this, the American Academy of Pediatrics recommends that middle schools and high schools begin no earlier than 8:30 a.m.

However the vast majority of middle and high schools start earlier than recommended. According to the 2014 School Health Policies and Practices Study from the Centers for Disease Control and Prevention, 93% of high schools and 83% of middle schools in the U.S. started before 8:30 a.m.

Given this, Dr. Gelfand and her team set out to answer the following question: If teens with migraine are attending a school that follows that recommendation and starts no earlier than 8:30 a.m., do they have a lower headache frequency?

What the Study Found

Dr. Gelfand and her team set up a survey and recruited high school students nationally using social media advertisements. The survey screened them for migraine using questions that followed migraine diagnosis criteria and asked them a number of questions about their headache frequency, whether or not they’re on preventative medications, and about their sleep schedules. The team surveyed more than 1,000 high school students. The respondents were split pretty evenly between students who attended schools that began earlier than 8:30 a.m. and students who attended schools that began at 8:30 a.m. or later.

The study found that adolescents who went to schools that started at the recommended time had a lower self-reported headache frequency than those who attended school that started earlier. The results were the same when adjusting for age, sex, total sleep time, and sleep schedule variability.

There were some limitations to the study, says Dr. Gelfand. For example, how often participants had headaches was based on self-reported data rather than data from a headache diary, which is the standard in a headache treatment trial. The study also determined whether or not the students had migraine through screening questions rather than a clinician confirming the diagnosis.

However, Dr. Gelfand hopes that the results of this study will allow them to get funding to try to confirm these findings in a study using a clinician to diagnose migraine, having participants keep a ongoing headache diary, and including some details on sleep. “We can really confirm and nail down this effect and start to try to examine what’s underlying it,” says. Dr. Gelfand.

What Can Parents Do?

There’s a growing body of evidence that starting school later is good for teens for many reasons. “It’s not just about migraine,” Dr. Gelfand says. “It’s about performance. It’s about absenteeism and even things like car accidents on their way to school. There are a lot of health benefits to starting schools later.”

Despite the growing evidence, the fact remains that there are still some practical challenges. However, California recently became the first state to legislate that high schools begin no earlier than 8:30 a.m. This law will go into effect in the 2022 to 2023 school year. California’s experience can serve as a helpful model for other states looking to do the same thing, says Dr. Gelfand.

Parents can advocate for later school start times by talking to their school boards and school district leadership, Dr. Gelfand says. “I think we have to advocate for why this is important for adolescent health and why we need to make these changes, and not just keep doing things the way they used to be done,” she says.

Funding for the study was provided by the UCSF Resource Allocation Program.

The American Migraine Foundation is committed to improving the lives of those living with this debilitating disease. For more of the latest news and information on migraine, visit the AMF Resource Library or Pediatric Migraine Content Hub. For help finding a healthcare provider, check out our Find a Doctor tool. Together, we are as relentless as migraine.