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. 2025 Apr 10;34(5):e70066. doi: 10.1111/jsr.70066

Evening Chronotype Associates With Worse Physical and Mental Health and Headache‐Related Disability Among Migraine Patients

Daniel Baksa 1,2,3, Nora Eszlari 1,2, Dora Torok 1,2, Gabor Hullam 4, Gyorgy Bagdy 1,2, Gabriella Juhasz 1,2,✉
PMCID: PMC12426698  PMID: 40205879

ABSTRACT

Migraine has been linked to chronotype, but with mixed results. Here, we tested chronotype in association with physical and mental health and headache characteristics in a large database of migraine patients and controls. A sample of the UK Biobank (n = 360,081; 58.3% female, mean age: 56.38) was used. Data included self‐reported chronotype, mental (neuroticism, depression, stress) and physical (body fat percentage, overall health rating) health factors, and migraine diagnosis based on ICD‐10 G43 diagnosis from healthcare data. Morning type controls (C morning, n = 210,775), evening type controls (C evening, n = 129,174), morning type migraine patients (M morning, n = 12,194), and evening type migraine patients (M evening, n = 7938) were compared. Additionally, in a subsample of questionnaire‐based migraine (n = 15,356), chronotype was tested in association with headache‐related features. One‐way ANOVA, Kruskal–Wallis test and chi‐squared test were run in SPSS 28 with Bonferroni correction. Evening chronotype was more frequent among migraine patients with an OR = 1.06, 95% CI [1.03; 1.09] compared to controls (χ 2 = 16.523, p < 0.001). The M evening group showed the worst level of all mental and physical health variables, while the C morning group reported the best values. Migraine patients with morning or evening chronotype showed a highly similar headache symptom profile, but the M evening subgroup expressed a higher disability (t = −3.965, p < 0.001). In conclusion, evening chronotype was associated with the worst physical and mental health status and the highest headache‐related disability among migraine patients, suggesting a need for elevated medical attention on chronotype in migraine.

Keywords: depression, eveningness, headache, migraine, morningness

1. Introduction

According to the most recent Global Burden of Disease study, the worldwide incidence of migraine increased by 40.5% from 1990 to 2019 (Fan et al. 2023). Despite the high rate, migraine is still often under‐ and misdiagnosed; therefore, many people with migraine do not receive proper treatment (Ashina et al. 2021). Furthermore, even novel migraine‐specific drugs are not effective in all cases; e.g., anti‐CGRP medications show a 50%–60% efficacy rate among migraine patients (Guo et al. 2022). The high heterogeneity of people with migraine, including variability in, e.g., symptom profile, disability, comorbid disorders, migraine subtype‐ and sex‐related mechanisms, and the involvement of multiple pathophysiological pathways, probably represents the main challenge in migraine therapy (Juhasz et al. 2023). One further, lesser‐known factor contributing to this heterogeneity and possibly modifying treatment efficacy might be the chronotype of migraine patients.

Chronotype or morningness‐eveningness is generally defined as the individual's preference for the timing of activity and rest during the 24‐h day. Chronotype depends on multiple factors, including sex, age, genetic, environmental, and psychosocial components, and shows a nearly normal distribution in the population: most people are intermediate type, while the extreme sides of the spectrum are represented by morning (or lark) and evening (or owl) types (Roenneberg et al. 2003; Urbán et al. 2011; van Oosterhout et al. 2018). Both extreme types have been linked to several conditions (van Oosterhout et al. 2018); however, generally, the evening type is considered the more vulnerable one, mostly because of its association with psychiatric disorders, including comorbid diseases of migraine, such as major depressive disorder and bipolar disorder (Kivelä et al. 2018). Furthermore, a study found that healthy males with evening chronotype showed a lower pain threshold compared to healthy males with morning chronotype, regardless of the time of day (Jankowski 2013). These results suggest that evening chronotype might also be associated with migraine, but the related few studies showed mixed results (Benkli et al. 2023). Some authors detected a higher ratio of both extreme chronotypes among migraine patients compared to healthy controls (Gori et al. 2005; van Oosterhout et al. 2018), while others found an association between migraine and solely evening chronotype (Bruni et al. 2008), but most studies were not able to show any differences in chronotype distribution between migraine patients and controls (Cevoli et al. 2010; Kouhi Fayegh et al. 2023; Kozak et al. 2017; McAdams et al. 2020; Ong et al. 2018). Effects of chronotype on headache characteristics were also revealed: morning chronotype usually correlated with an attack starting in the morning, while evening chronotype correlated with an attack onset in the afternoon/evening (Im et al. 2019; van Oosterhout et al. 2018), a higher attack frequency (Im et al. 2019), and an earlier search for medical help because of headache symptoms (Viticchi et al. 2019).

However, the related investigations were conducted with low sample sizes (usually between 100 and 200 participants, and the largest one (van Oosterhout et al. 2018) around 3000)—representing an obvious limitation. Here, we used a large database to explore differences between migraine patients and controls (1) in the distribution of morning and evening chronotypes, and (2) in physical and mental health factors in association with chronotype; furthermore, (3) to compare headache characteristics of people with migraine showing morning or evening chronotype.

2. Methods

2.1. Study Population and Phenotype Data

In our cross‐sectional study, participants were selected from the UK Biobank (UKB, Application no. 71718) dataset: n = 360,081 subjects provided complete data for our main analysis. The following self‐reported data were used: age and sex as general descriptive data; neuroticism, current depression symptoms, and stressful events in the last 2 years as mental health factors; body fat percentage (BFP) and overall health rating as physical health variables. Chronotype was measured with the following question: “Do you consider yourself to be?” with the following options: (1) “definitely a ‘morning’ person”, (2) “more a ‘morning’ than ‘evening’ person”, (3) “more an ‘evening’ than ‘morning’ person”, (4) “definitely an ‘evening’ person”, (5) “do not know”. In our analyses, we defined two broad categories by combining options (1) and (2) for a morning chronotype and options (3) and (4) for an evening chronotype (participants with a “do not know” answer were excluded). Migraine diagnosis was based on the G43 ICD‐10 code derived from hospital inpatient, primary care, and death registry data (for further details, see UKB Resource 593). Controls were defined as not having a G43 diagnosis. The following study groups were created: (1) controls with morning chronotype (C morning, n = 210,775), (2) controls with evening chronotype (C evening, n = 129,174), (3) migraine patients with morning chronotype (M morning, n = 12,194), and (4) migraine patients with evening chronotype (M evening, n = 7938).

During an online follow‐up by the UKB, a subset of participants provided detailed data on pain symptoms, including headache characteristics by filling out the Experience of Pain questionnaire (UKB Category ID: 154). From this smaller database, n = 15,356 participants with questionnaire‐based migraine were used to compare headache‐related features of subjects with morning (n = 8972) to subjects with evening (n = 6384) chronotype. In this additional analysis, the following variables were utilised: age, sex and chronotype—similarly as in the main analysis; furthermore, monthly headache frequency, headache‐related disability in the last 3 months, the presence of prodromal symptoms, unilateral headache pain, pulsating‐throbbing headache pain, moderate–severe headache pain intensity, aggravation of headache pain by routine physical activity, sickness during headache, photophobia, phonophobia, visual and sensory aura. Questionnaire‐based migraine was defined as a “yes” answer to the following question: “Have you ever been told by a doctor that you have had migraine?” Headache symptoms and severity data were measured by a simplified version of a validated questionnaire which showed a 100% sensitivity and 82.3% specificity for migraine diagnosis and was used in the large‐scale, representative American Migraine Prevalence and Prevention (AMPP) Study by Lipton et al. (2007). For further details on all variables and related derivation protocols, see Supporting Information Table S1.

Reliability of the neuroticism and current depression scales was tested, which indicated adequate levels of internal consistency (Cronbach's alpha: 0.772 for neuroticism, and 0.775 for current depression).

Ethical approval was given by the National Research Ethics Service Committee North West–Haydock. All procedures were carried out in accordance with the Declaration of Helsinki. All participants provided written informed consent.

2.2. Statistical Analysis

IBM SPSS Statistics 28 (IBM Corp, Armonk, NY, USA) was used for data analysis. Study groups were compared with one‐way ANOVA, post hoc Games‐Howell test, Kruskal–Wallis test, post hoc Mann–Whitney test, chi‐squared test, and post hoc z‐test. To adjust for multiple testing, a Bonferroni‐corrected threshold of p ≤ 0.0071 (0.05/7) was applied in the main analysis (i.e., comparing the measured 7 variables between the four study groups), and a p ≤ 0.0035 (0.05/14) threshold in the additional analysis (i.e., comparing the measured 14 variables between the two migraine subgroups). In the case of post hoc tests, a p ≤ 0.05 threshold was used.

3. Results

3.1. Distribution of Morning and Evening Chronotypes in Migraine Patients and Controls

Among controls, 62% reported a morning chronotype, and 38% an evening chronotype; among migraine patients, 60.6% a morning chronotype, and 39.4% an evening chronotype. There was a significant association between migraine/control status and chronotype (χ 2 = 16.523, p < 0.001). Based on the odds ratio (OR), the odds of morning chronotype were 1.06 times higher among controls compared to migraine patients (in other words, evening chronotype was more frequent among migraine patients with an OR = 1.06, 95% CI [1.03; 1.09] compared to controls). For further details, see Supporting Information Table S2.

3.2. Main Analysis Results: Comparison Between Migraine Patients and Controls With Morning or Evening Chronotype

Descriptive statistics and results of the comparison between migraine patients and controls with morning or evening chronotype are shown in Table 1 (details on post hoc tests can be found in Supporting Information Table S3). Significant differences emerged between the groups in all measured data. Regarding general descriptive data, females dominated every group, especially the two migraine groups; while the age showed the following descending order: C morning > M morning > C evening > M evening.

TABLE 1.

Descriptive statistics and the comparison between migraine patients and controls with morning or evening chronotype.

Total C morning (C m ) C evening (C e ) M morning (M m ) M evening (M e ) Group comparisons

Participant number

(n, %)

 360,081 210,775 (58.5%)

129,174

(35.9%)

 12,194 (3.4%) 7938 (2.2%)
Age (mean, SD)

56.38

(8.08)

57.01

(7.91)

55.54

(8.28)

55.82

(7.81)

54.37

(8.07)

 F(3) = 1084.691, p < 0.001 (C m  > M m  > C e  > M e )
Sex (n, %)
Male 150,262 (41.7%)

88,530

(42%)

57,219

(44.3%)

 2715 (22.3%) 1798 (22.7%) χ 2(3) = 3444.606, p < 0.001 (C m , C e , M m , M e : female > male)
Female 209,819 (58.3%)

122,245

(58%)

71,955

(55.7%)

 9479 (77.7%) 6140 (77.3%)
Neuroti‐cism (mean, SD)

5

(3.02)

4.8

(2.95)

5.22

(3.08)

5.44

(3.05)

6

(3.17)

 F(3) = 899.135, p < 0.001 (M e  > M m  > C e  > C m )
Current depression (mean, SD)

5.88

(2.23)

5.7

(2.11)

6.1

(2.36)

6.09

(2.32)

6.66

(2.62)

F(3) = 1261.708, p < 0.001 (M e  > M m  = C e  > C m )
Stressful events in the last 2 years (n, %)
None 193,874 (53.8%) 116,868 (55.4%)

66,953

(51.8%)

 6292 (51.6%)

3761

(47.4%)

 H(3) = 825.43, p < 0.001 (M e  > M m  = C e  > C m )
Low 120,436 (33.4%)

69,629

(33%)

44,007

(34.1%)

 4121 (33.8%)

2679

(33.7%)
Moderate or high 45,771 (12.7%)

24,278

(11.5%)

 18,214 (14.1%) 1781 (14.6%)

1498

(18.9%)

BFP

(mean, SD)

31.92

(8.53)

31.78

(8.44)

31.77

(8.67)

34.02

(8.14)

34.52

(8.34)

 F(3) = 523.609, p < 0.001 (M e  > M m  > C e  = C m )
Overall health rating (n, %)
Excellent 54,263 (15.1%) 34,717 (16.5%) 17,223 (13.3%) 1543 (12.7%)

780

(9.8%)

 H(3) = 2438.214, p < 0.001 (M e  > C e  > M m  > C m )
Good 209,732 (58.2%) 125,357 (59.5%) 72,956 (56.5%) 7187 (58.9%) 4232 (53.3%)
Fair 79,428 (22.1%) 42,848 (20.3%) 31,571 (24.4%) 2787 (22.9%) 2222 (28%)
Poor 16,658 (4.6%)

7853

(3.7%)

7424

(5.7%)

677

(5.6%)

704

(8.9%)
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Note: Table 1 shows descriptive data and statistical results of the comparison between migraine patients and controls with morning or evening chronotype. Results of one‐way ANOVA, Kruskal–Wallis and chi‐squared tests with a Bonferroni‐corrected p < 0.0071 threshold are shown. In case of significant results, the directions of differences are presented in brackets (the exact results of these post hoc tests can be found in Supporting Information Table S3). For further details on all variables and related derivation protocols, see Supporting Information Table S1.

Abbreviations: χ 2, chi‐squared test statistic; BFP, body fat percentage; C evening (C e ), controls with evening chronotype; C morning (C m ), controls with morning chronotype; F, one‐way ANOVA test statistic; H, Kruskal–Wallis test statistic; M evening (M e ), migraine patients with evening chronotype; M morning (M m ), migraine patients with morning chronotype; p, p value; SD, standard deviation.

Regarding mental health variables, the level of neuroticism, current depression symptoms, and life stress was the highest among the M evening group, and the lowest in the C morning group. The other two groups showed intermediate values: the M morning group reported a higher level of neuroticism, but no difference was found in current depression and stress compared to the C evening group. A similar pattern was detected in physical health factors. Concerning overall health rating, the M evening group expressed the worst level, while the C morning group expressed the best level. Furthermore, the M morning group reported better overall health than the C evening group. BFP was also the highest among the M evening group. The M morning group also showed a higher BFP value in comparison with the two control groups.

3.3. Additional Analysis Results: Headache‐Related Features of People With Questionnaire‐Based Migraine Showing Morning or Evening Chronotype

The headache‐related results of the subset with questionnaire‐based migraine showing morning or evening chronotype are collected in Table 2. The M morning group was a bit older than the M evening group, but no significant difference was found in sex ratios. Furthermore, a higher level of headache‐related disability and a higher frequency of unilateral headache pain was reported by the M evening group in comparison with the M morning group. The two groups did not differ significantly in any other headache‐related variable, although the M evening group tends to report a higher attack frequency.

TABLE 2.

Headache‐related results of the subset with questionnaire‐based migraine showing morning or evening chronotype.

Total M morning (M m ) M evening (M e ) Group comparisons
Participant number (n, %) 15,356 8972 (58.4%) 6384 (41.6%)
Age (mean, SD) 53.4 (7.49) 53.9 (7.41) 52.71 (7.55) t(13587.66) = 9.677, p < 0.001 (M m  > M e )
Sex (n, %)
Male 3474 (22.6%) 1960 (21.8%) 1514 (23.7%) χ 2(1) = 7.45, p = 0.006
Female 11,882 (77.4%) 7012 (78.2%) 4870 (76.3%)
Headache frequency (mean, SD) 6.85 (7.19) 6.71 (7.06) 7.03 (7.351) t(15354) = −2.662, p = 0.004
Headache‐related disability (mean, SD) 4.13 (9.26) 3.87 (8.53) 4.49 (10.18)

t(12189.986) = −3.965, p < 0.001

(M e  > M m )
Prodromal symptoms (n, %)
No 4111 (26.8%) 2429 (27.1%) 1682 (26.3%)

χ 2(1) = 1.003, p = 0.317
Yes 11,245 (73.2%) 6543 (72.9%) 4702 (73.7%)
Unilateral headache pain (n, %)
No 2090 (13.6%) 1294 (14.4%) 796 (12.5%)

χ 2(1) = 12.112, p < 0.001 (M e  > M m )
Yes 13,266 (86.4%) 7678 (85.6%) 5588 (87.5%)
Pulsating‐throbbing headache pain (n, %)
No 1036 (6.7%) 627 (7%) 409 (6.4%) χ 2(1) = 2.007, p = 0.157
Yes 14,320 (93.3%) 8345 (93%) 5975 (93.6%)
Moderate–severe headache pain intensity (n, %)
No 168 (1.1%) 110 (1.2%) 58 (0.9%) χ 2(1) = 3.475, p = 0.062
Yes 15,188 (98.9%) 8862 (98.8%) 6326 (99.1%)
Aggravation of headache pain by routine physical activity (n, %)
No 4787 (31.2%) 2862 (31.9%) 1925 (30.2%) χ 2(1) = 5.298, p = 0.021
Yes 10,569 (68.8%) 6110 (68.1%) 4459 (69.8%)
Sickness during headache (n, %)
No 2162 (14.1%) 1294 (14.4%) 868 (13.6%)

χ 2(1) = 2.105, p = 0.147
Yes 13,194 (85.9%) 7678 (85.6%) 5516 (86.4%)
Photophobia (n, %)
No 1113 (7.2%) 676 (7.5%) 437 (6.8%)

χ 2(1) = 2.636, p = 0.104
Yes 14,243 (92.8%) 8296 (92.5%) 5947 (93.2%)
Phonophobia (n, %)
No 1512 (9.8%) 899 (10%) 613 (9.6%)

χ 2(1) = 0.734, p = 0.392
Yes 13,844 (90.2%) 8073 (90%) 5771 (90.4%)
Visual aura (n, %)
No 7938 (51.7%) 4617 (51.5%) 3321 (52%)

χ 2(1) = 0.469, p = 0.493
Yes 7418 (48.3%) 4355 (48.5%) 3063 (48%)
Sensory aura (n, %)
No 13,636 (88.8%) 7988 (89%) 5648 (88.5%) χ 2(1) = 1.182, p = 0.277
Yes 1720 (11.2%) 984 (11%) 736 (11.5%)
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Note: Table 2 shows headache‐related results of the subset with questionnaire‐based migraine showing morning or evening chronotype. Results of independent samples t‐tests and chi‐squared tests with a Bonferroni‐corrected p < 0.0035 threshold are shown. In case of significant results, the directions of differences are presented in brackets. For further details on all variables and related derivation protocols, see Supporting Information, Table S1.

Abbreviations: χ 2, chi‐squared test statistic; M evening (M e ), people with migraine showing evening chronotype; M morning (M m ), people with migraine showing morning chronotype; p, p value; t, independent samples t‐test statistic; SD, standard deviation.

Based on the migraine diagnosis criteria which were used in the AMPP Study by Lipton et al. (Lipton et al. 2001, 2007) (for derivation protocol, see Supporting Information Table S1), 95.2% of this sample can be further validated as having migraine, among morning people: 94.9%, and evening people: 95.6%.

4. Discussion

So far, this is the largest study investigating the relationship between migraine and chronotype, and chronotype‐dependent mental and physical health status of migraine patients. Morning chronotype was more often reported by both migraine patients and controls; however, individuals with migraine still had a little higher chance for eveningness compared to controls. Evening‐type migraine patients showed the worst level of mental and physical health in all measured categories, while morning‐type controls were in the best state. Moreover, the analysis with a subsample with questionnaire‐based migraine also revealed a highly similar headache‐related symptom profile of individuals with morning or evening chronotype; nevertheless, evening‐type persons expressed a higher level of headache‐related disability than those with morning chronotype.

Various mental and physical health factors have been linked to both migraine and chronotype. We already discussed in the Introduction the association between evening chronotype and comorbid psychiatric diseases of migraine, specifically major depressive disorder and bipolar disorder (Kivelä et al. 2018). Thus, the highest level of current depression symptoms among evening‐type migraine patients in our study is not surprising. Interestingly, a recent study with bipolar disorder patients also showed a higher frequency of evening chronotype among patients with comorbid migraine compared to non‐migraine patients (Romo‐Nava et al. 2021)—proposing a role for evening chronotype even in the relationship between migraine and its comorbid disorders, at least bipolar disorder. Neuroticism or emotional instability is also a common correlate of migraine (Galvez‐Sánchez and Montoro Aguilar 2022) and chronotype (Antypa et al. 2017). Inconsistent results emerged regarding the association of neuroticism and morningness‐eveningness (Antypa et al. 2017; Lipnevich et al. 2017), but a meta‐analysis revealed a unique, negative association between neuroticism and morningness (Lipnevich et al. 2017). Furthermore, high neuroticism seems to enhance the risk of depression symptoms, specifically among evening‐type individuals (Gorgol et al. 2022). Our study identified the highest neuroticism level in evening‐type migraine patients (and the lowest among morning‐type controls) which is in line with these previous results. Stress plays multiple roles in migraine, including, e.g., triggering attacks, amplifying attack intensity, possibly contributing to migraine chronification, and comorbidities with stress‐related disorders (such as major depressive disorder), causing relapse and diminishing treatment efficacy (Sauro and Becker 2009; Wacogne et al. 2003). Evening chronotype has been linked to higher perceived stress (Gębska et al. 2022; Saalwirth and Leipold 2021) and might be a risk factor for pathologic stress responses (McCall et al. 2023). Again, the highest level of stressful events among evening‐type migraine patients that we detected fits well with these previous observations.

Regarding BFP, the association of migraine with obesity and, in some cases, also with underweight has been confirmed by multiple meta‐analyses (Gelaye et al. 2017; Hatami et al. 2021; Martami et al. 2022; Ornello et al. 2015). Evening‐type adults are generally more prone to show unhealthy behaviour, including following an unhealthy diet compared to morning‐type individuals (Maukonen et al. 2016), and a recent meta‐analysis strengthened the association of eveningness with obesity and adverse characteristics of glucose and lipid metabolism (Zhang et al. 2022). Our result showing the highest BFP among evening‐type migraine patients corresponds well with these previous findings. Finally, poorer perceived health has also been reported by individuals with migraine compared to controls (Glavor et al. 2019; Popit et al. 2020), and with evening compared to morning chronotype (Haraszti et al. 2014; Maukonen et al. 2016)—which is similarly well reflected in our study: evening‐type migraine patients expressed the worst level of overall health.

Thus, all our results suggest that evening chronotype is a risk factor for adverse mental and physical health symptoms among migraine patients. Although this higher general vulnerability was not reflected in headache symptoms among people with migraine: morning and evening types showed an almost identical symptom profile. Despite this strong similarity, subjects with evening type still reported a higher headache‐related disability. Hence, we can conclude that this increased interference with work and spare time is not a consequence of differing or more frequent headache symptoms; rather, it might be associated with the mentioned general vulnerability brought by evening chronotype itself. Similarly, among controls, evening‐type individuals also showed a more disadvantageous mental and physical status in all measured categories compared to morning‐type people. Furthermore, controls with evening chronotype reported comparable levels of depression and stress and even worse overall health in comparison with morning‐type migraine patients.

Based on these data, we propose that chronotype should be considered during the treatment of migraine patients. Here, we have to note that evening chronotype is not unfavourable, per se. Disadvantages may occur when someone maintains a lifestyle which is not in synchrony with his/her chronotype, and evening‐type individuals are generally more often exposed to such situations because of asynchronous social and occupational demands. Social jetlag, defined as the time difference between the sleep midpoint of work‐ and free days, occurs in case of a discrepancy between someone's biological rhythm and the diurnal timing of activities and rest dictated by social constraints, and represents a proxy for circadian misalignment which can be considered a chronic stress factor increasing the risk of various physical and mental disorders (Roenneberg et al. 2003; Sűdy et al. 2019; Taillard et al. 2021; Wittmann et al. 2006). A general recommendation is to adapt work/school and other social schedules to chronotype as much as possible (Wittmann et al. 2006). In the case of migraine, the therapeutic effect of sleep in terminating acute migraine attack pain was suggested many decades ago (Blau 1982); however, regular sleep in the daytime can enhance poor sleep hygiene and lead to circadian misalignment and its negative consequences, and possibly to worsening headache symptoms—similarly, migraine medication can help in acute attack relief, but medication overuse leads to migraine chronification. Shift and night work has also been associated with migraine, migraine chronification and an increase in headache‐related disability, although with conflicting results (Leso et al. 2020; Sandoe et al. 2019).

Migraine treatment may also directly benefit from circadian adaptations. For example, early morning migraine attacks were successfully prevented by a sumatriptan succinate in a press‐coated floating pulsatile tablet form, administered at bedtime and designed to accomplish drug delivery during the morning (Jagdale and Pawar 2014). Furthermore, a pilot randomised controlled trial with chronic migraine patients investigated the effect of exercise on migraine burden controlling exercise timing and synchrony with chronotype, and concluded that only the latter factor had a significant effect: migraine burden improved after regular ‘in‐sync’ exercise, but not in the case of ‘out‐of‐sync’ exercise (Malek et al. 2023). Interestingly, a novel 12‐month real‐life study with erenumab detected a change in chronotype among chronic migraine patients: at three‐month assessment, the frequency of morningness significantly reduced in favour of intermediate chronotype, and, although this change has not reached a statistically significant level at later follow‐up points, the authors observed a similar trend—suggesting an association between migraine, CGRP and circadian rhythm (Pilati et al. 2023) which needs to be further tested.

5. Limitations

A cross‐sectional study was run; therefore, the causative effect of chronotype could not be measured. In our main analysis, migraine was based on ICD‐10 diagnosis using hospital inpatient, primary care, and death registry data; while in the additional analysis, a self‐reported doctor's diagnosis of migraine was applied, which was confirmed by the symptom‐based criteria of (Lipton et al. 2001, 2007)—providing a good validation for our study. In the case of other self‐reported data, social desirability bias cannot be excluded. Controls were defined as not having migraine, and we have not corrected for any other disorders—still, we were able to detect differences between the study groups. Future studies screening for the effects of migraine comorbidities and chronotype‐related conditions might reveal more precise details regarding the connection between migraine and chronotype. Moreover, the inclusion of migraine subtypes (e.g., episodic and chronic migraine, migraine with and without aura) could also identify subtype‐dependent associations. Chronotype was measured with a simple question, and we used rather broad definitions of morningness and eveningness, not including an intermediate group. At the moment, there is no agreement in the literature about the number of types (e.g., two, three or even more types were studied) (Urbán et al. 2011). Future studies with a more precise chronotype measurement (e.g., the Munich ChronoType Questionnaire, (Roenneberg et al. 2003)) and more chronotype categories could explore further aspects of the relationship between migraine and chronotype. Nonetheless, with the use of broad chronotype categories, we were able to capture chronotype‐related differences. Females were overrepresented in our sample, especially among the migraine groups, which is in line with the known higher prevalence of migraine among women compared to men. The study groups also showed minor differences in age; although, they all represented mostly middle‐aged individuals of the same age group. Since both migraine and chronotype show age‐dependent variations, future studies should include a comparison of different age groups.

6. Conclusions

In conclusion, evening chronotype is associated with the worst physical and mental health status, and the highest level of headache‐related disability among migraine patients, suggesting a need for heightened medical attention in this specific patient group and urging future studies to further test possible chronotherapeutic options in migraine treatment.

Author Contributions

Daniel Baksa: conceptualization, formal analysis, writing – original draft, writing – review and editing. Nora Eszlari: writing – review and editing, software, formal analysis. Dora Torok: software, formal analysis. Gabor Hullam: software, formal analysis, writing – review and editing. Gyorgy Bagdy: supervision, funding acquisition. Gabriella Juhasz: conceptualization, funding acquisition, supervision, writing – review and editing.

Ethics Statement

For this study, the UK Biobank dataset (application number 71718) was used. Ethical approval was given by the National Research Ethics Service Committee North West–Haydock. All procedures were carried out in accordance with the Declaration of Helsinki.

Consent

All participants provided written informed consent.

Conflicts of Interest

Preliminary results were presented at PhD Scientific Days, Semmelweis University, 22–23 June 2023, Budapest (lecture), and at the 7th European Congress of NeuroRehabilitation, 30 August–2 September 2023, Lyon, hybrid (poster presentation)—a related abstract was published in NEUROLOGIE UND REHABILITATION 29: S1 p. S125 Paper: P192 (2023). G.B. is a member of the Board of Directors at Gedeon Richter, but the company did not provide any funding or have any further role in the preparation of this article. All other authors declare no conflicts of interest.

Supporting information

Data S1. Supporting Information.

JSR-34-e70066-s001.docx (32.9KB, docx)

Acknowledgements

This research has been conducted using the UK Biobank Resource under Application Number 71718. This work uses data provided by patients and collected by the NHS as part of their care and support. Copyright 2019, NHS England. Re‐used with the permission of the UK Biobank. All rights reserved.

Baksa, D. , Eszlari N., Torok D., Hullam G., Bagdy G., and Juhasz G.. 2025. “Evening Chronotype Associates With Worse Physical and Mental Health and Headache‐Related Disability Among Migraine Patients.” Journal of Sleep Research 34, no. 5: e70066. 10.1111/jsr.70066.

Funding: This work was supported by New National Excellence Program of the Ministry for Culture and Innovation from the source of the National Research, Development and Innovation Fund, ÚNKP‐22‐4‐I‐SE‐10, ÚNKP‐22‐4‐II‐SE‐1; Hungarian National Research, Development, and Innovation Office, K 143391; National Research, Development and Innovation Office, Hungary, under the frame of ERA PerMed (ERAPERMED2019‐108), 2019‐2.1.7‐ERA‐NET‐2020‐00005; Ministry of Innovation and Technology of Hungary from the National Research, Development and Innovation Fund, financed under the TKP2021‐EGA funding scheme, TKP2021‐EGA‐25, and TKP2021‐EGA‐02; Thematic Excellence Programme (Tématerületi Kiválósági Program) of the Ministry for Innovation and Technology in Hungary, within the framework of the Neurology and Translational Biotechnology thematic programmes of the Semmelweis University, 2020‐4.1.1.‐TKP2020; Hungarian Brain Research Program 3.0, NAP2022‐I‐4/2022; Hungarian Brain Research Program, 2017‐1.2.1‐NKP‐2017‐00002; Hungarian Academy of Sciences (MTA‐SE Neuropsychopharmacology and Neurochemistry Research Group); NE is supported by the János Bolyai Research Scholarship of the Hungarian Academy of Sciences; DT is a recipient of PhD scholarship from Doctoral School of Pharmaceutical Sciences, Semmelweis University, Hungary. The sponsors had no further role in the study design; in the collection, analysis and interpretation of data; in the writing of the report; and in the decision to submit the article for publication.

Data Availability Statement

For this study, the UK Biobank dataset (application number 71718) was used under standard terms and conditions. Data are available from the UK Biobank–for detailed information, see: https://www.ukbiobank.ac.uk/.

References

  1. Antypa, N. , Verkuil B., Molendijk M., Schoevers R., Penninx B., and Van Der Does W.. 2017. “Associations Between Chronotypes and Psychological Vulnerability Factors of Depression.” Chronobiology International 34, no. 8: 1125–1135. 10.1080/07420528.2017.1345932. [DOI] [PubMed] [Google Scholar]
  2. Ashina, M. , Katsarava Z., Do T. P., et al. 2021. “Migraine: Epidemiology and Systems of Care.” Lancet 397, no. 10283: 1485–1495. 10.1016/s0140-6736(20)32160-7. [DOI] [PubMed] [Google Scholar]
  3. Benkli, B. , Kim S. Y., Koike N., et al. 2023. “Circadian Features of Cluster Headache and Migraine: A Systematic Review, Meta‐Analysis, and Genetic Analysis.” Neurology 100, no. 22: e2224–e2236. 10.1212/wnl.0000000000207240. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Blau, J. N. 1982. “Resolution of Migraine Attacks: Sleep and the Recovery Phase.” Journal of Neurology, Neurosurgery, and Psychiatry 45, no. 3: 223–226. 10.1136/jnnp.45.3.223. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Bruni, O. , Russo P. M., Ferri R., Novelli L., Galli F., and Guidetti V.. 2008. “Relationships Between Headache and Sleep in a Non‐Clinical Population of Children and Adolescents.” Sleep Medicine 9, no. 5: 542–548. 10.1016/j.sleep.2007.08.010. [DOI] [PubMed] [Google Scholar]
  6. Cevoli, S. , Nicodemo M., Grimaldi D., et al. 2010. “Chronotypes in Menstrual Migraine: A Case‐Control Study.” Neurological Sciences: Official Journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology 31, no. Suppl 1: S163–S164. 10.1007/s10072-010-0315-4. [DOI] [PubMed] [Google Scholar]
  7. Fan, L. , Wu Y., Wei J., et al. 2023. “Global, Regional, and National Time Trends in Incidence for Migraine, From 1990 to 2019: An Age‐Period‐Cohort Analysis for the GBD 2019.” Journal of Headache and Pain 24, no. 1: 79. 10.1186/s10194-023-01619-9. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Galvez‐Sánchez, C. M. , and Montoro Aguilar C. I.. 2022. “Migraine and Neuroticism: A Scoping Review.” Behavioral Science 12, no. 2: 30. 10.3390/bs12020030. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Gębska, M. , Dalewski B., Pałka Ł., Kołodziej Ł., and Sobolewska E.. 2022. “Chronotype Profile, Stress, Depression Level, and Temporomandibular Symptoms in Students With Type D Personality.” Journal of Clinical Medicine 11, no. 7: 1886. 10.3390/jcm11071886. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Gelaye, B. , Sacco S., Brown W. J., Nitchie H. L., Ornello R., and Peterlin B. L.. 2017. “Body Composition Status and the Risk of Migraine: A Meta‐Analysis.” Neurology 88, no. 19: 1795–1804. 10.1212/wnl.0000000000003919. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Glavor, K. D. , Titlić M., Vuletić G., Mrđen A., and Šimunić M. M.. 2019. “Quality of Life Assessment in Migraine and Relapsing Remitting Multiple Sclerosis: Self‐Perceived Health Is Similar.” Neurological Sciences: Official Journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology 40, no. 12: 2549–2554. 10.1007/s10072-019-04005-z. [DOI] [PubMed] [Google Scholar]
  12. Gorgol, J. , Waleriańczyk W., and Stolarski M.. 2022. “The Moderating Role of Personality Traits in the Relationship Between Chronotype and Depressive Symptoms.” Chronobiology International 39, no. 1: 106–116. 10.1080/07420528.2021.1979995. [DOI] [PubMed] [Google Scholar]
  13. Gori, S. , Morelli N., Maestri M., Fabbrini M., Bonanni E., and Murri L.. 2005. “Sleep Quality, Chronotypes and Preferential Timing of Attacks in Migraine Without Aura.” Journal of Headache and Pain 6, no. 4: 258–260. 10.1007/s10194-005-0201-2. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Guo, S. , Ernstsen C., Hay‐Schmidt A., et al. 2022. “PACAP Signaling Is Not Involved in GTN‐ and Levcromakalim‐Induced Hypersensitivity in Mouse Models of Migraine.” Journal of Headache and Pain 23, no. 1: 155. 10.1186/s10194-022-01523-8. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Haraszti, R. , Purebl G., Salavecz G., Poole L., Dockray S., and Steptoe A.. 2014. “Morningness‐Eveningness Interferes With Perceived Health, Physical Activity, Diet and Stress Levels in Working Women: A Cross‐Sectional Study.” Chronobiology International 31, no. 7: 829–837. 10.3109/07420528.2014.911188. [DOI] [PubMed] [Google Scholar]
  16. Hatami, M. , Soveid N., Lesani A., Djafarian K., and Shab‐Bidar S.. 2021. “Migraine and Obesity: Is There a Relationship? A Systematic Review and Meta‐Analysis of Observational Studies.” CNS & Neurological Disorders Drug Targets 20, no. 9: 863–870. 10.2174/1871527320666210713114840. [DOI] [PubMed] [Google Scholar]
  17. Im, H. J. , Baek S. H., Yun C. H., and Chu M. K.. 2019. “Time Preference of Headache Attack and Chronotype in Migraine and Tension‐Type Headache.” Chronobiology International 36, no. 11: 1528–1536. 10.1080/07420528.2019.1658202. [DOI] [PubMed] [Google Scholar]
  18. Jagdale, S. C. , and Pawar C. R.. 2014. “Application of Design of Experiment for Polyox and Xanthan Gum Coated Floating Pulsatile Delivery of Sumatriptan Succinate in Migraine Treatment.” BioMed Research International 2014: 547212. 10.1155/2014/547212. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Jankowski, K. S. 2013. “Morning Types Are Less Sensitive to Pain Than Evening Types all Day Long.” European Journal of Pain 17, no. 7: 1068–1073. 10.1002/j.1532-2149.2012.00274.x. [DOI] [PubMed] [Google Scholar]
  20. Juhasz, G. , Gecse K., and Baksa D.. 2023. “Towards Precision Medicine in Migraine: Recent Therapeutic Advances and Potential Biomarkers to Understand Heterogeneity and Treatment Response.” Pharmacology and Therapeutics 250: 108523. 10.1016/j.pharmthera.2023.108523. [DOI] [PubMed] [Google Scholar]
  21. Kivelä, L. , Papadopoulos M. R., and Antypa N.. 2018. “Chronotype and Psychiatric Disorders.” Current Sleep Medicine Reports 4, no. 2: 94–103. 10.1007/s40675-018-0113-8. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Kouhi Fayegh, A. , Mat Din H., Wan Sulaiman W. A., et al. 2023. “Relationship of Sleep Quality, Chronotype, and Obstructive Sleep Apnea With Migraine in the Elderly Population.” Neuropsychiatrie 38, no. 4: 174–181. 10.1007/s40211-023-00467-y. [DOI] [PubMed] [Google Scholar]
  23. Kozak, H. H. , Boysan M., Uca A. U., et al. 2017. “Sleep Quality, Morningness‐Eveningness Preference, Mood Profile, and Levels of Serum Melatonin in Migraine Patients: A Case‐Control Study.” Acta Neurologica Belgica 117, no. 1: 111–119. 10.1007/s13760-016-0723-1. [DOI] [PubMed] [Google Scholar]
  24. Leso, V. , Gervetti P., Mauro S., Macrini M. C., Ercolano M. L., and Iavicoli I.. 2020. “Shift Work and Migraine: A Systematic Review.” Journal of Occupational Health 62, no. 1: e12116. 10.1002/1348-9585.12116. [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. Lipnevich, A. A. , Credè M., Hahn E., Spinath F. M., Roberts R. D., and Preckel F.. 2017. “How Distinctive Are Morningness and Eveningness From the Big Five Factors of Personality? A Meta‐Analytic Investigation.” Journal of Personality and Social Psychology 112, no. 3: 491–509. 10.1037/pspp0000099. [DOI] [PubMed] [Google Scholar]
  26. Lipton, R. B. , Bigal M. E., Diamond M., Freitag F., Reed M. L., and Stewart W. F.. 2007. “Migraine Prevalence, Disease Burden, and the Need for Preventive Therapy.” Neurology 68, no. 5: 343–349. 10.1212/01.wnl.0000252808.97649.21. [DOI] [PubMed] [Google Scholar]
  27. Lipton, R. B. , Stewart W. F., Diamond S., Diamond M. L., and Reed M.. 2001. “Prevalence and Burden of Migraine in the United States: Data From the American Migraine Study II.” Headache 41, no. 7: 646–657. 10.1046/j.1526-4610.2001.041007646.x. [DOI] [PubMed] [Google Scholar]
  28. Malek, E. M. , Navalta J. W., and McGinnis G. R.. 2023. “Time of Day and Chronotype‐Dependent Synchrony Effects Exercise‐Induced Reduction in Migraine Load: A Pilot Cross‐Over Randomized Trial.” International Journal of Environmental Research and Public Health 20, no. 3: 2083. 10.3390/ijerph20032083. [DOI] [PMC free article] [PubMed] [Google Scholar]
  29. Martami, F. , Jayedi A., and Shab‐Bidar S.. 2022. “Primary Headache Disorders and Body Mass Index Categories: A Systematic Review and Dose‐Response Meta‐Analysis.” Headache 62, no. 7: 801–810. 10.1111/head.14356. [DOI] [PubMed] [Google Scholar]
  30. Maukonen, M. , Kanerva N., Partonen T., et al. 2016. “The Associations Between Chronotype, a Healthy Diet and Obesity.” Chronobiology International 33, no. 8: 972–981. 10.1080/07420528.2016.1183022. [DOI] [PubMed] [Google Scholar]
  31. McAdams, H. , Kaiser E. A., Igdalova A., et al. 2020. “Selective Amplification of ipRGC Signals Accounts for Interictal Photophobia in Migraine.” Proceedings of the National Academy of Sciences of the United States of America 117, no. 29: 17320–17329. 10.1073/pnas.2007402117. [DOI] [PMC free article] [PubMed] [Google Scholar]
  32. McCall, C. A. , Turkheimer E., Tsang S., Avery A., Duncan G. E., and Watson N. F.. 2023. “Quasi‐Causal Associations Between Chronotype and Post‐Traumatic Stress Disorder Symptoms: A Twin Study.” Sleep Health 9, no. 2: 218–227. 10.1016/j.sleh.2023.01.011. [DOI] [PubMed] [Google Scholar]
  33. Ong, J. C. , Taylor H. L., Park M., et al. 2018. “Can Circadian Dysregulation Exacerbate Migraines?” Headache 58, no. 7: 1040–1051. 10.1111/head.13310. [DOI] [PMC free article] [PubMed] [Google Scholar]
  34. Ornello, R. , Ripa P., Pistoia F., et al. 2015. “Migraine and Body Mass Index Categories: A Systematic Review and Meta‐Analysis of Observational Studies.” Journal of Headache and Pain 16: 27. 10.1186/s10194-015-0510-z. [DOI] [PMC free article] [PubMed] [Google Scholar]
  35. Pilati, L. , Torrente A., Di Marco S., et al. 2023. “Erenumab and Possible CGRP Effect on Chronotype in Chronic Migraine: A Real‐Life Study of 12 Months Treatment.” Journal of Clinical Medicine 12, no. 10: 3585. 10.3390/jcm12103585. [DOI] [PMC free article] [PubMed] [Google Scholar]
  36. Popit, M. , Zaletel‐Kragelj L., Eržen I., Zadravec‐Zaletel L., and Zaletel M.. 2020. “Estimation of the Impact of Migraine on Self‐Rated Health: A Cross‐Sectional Study in Slovenia.” Zdravstveno Varstvo 60, no. 1: 38–45. 10.2478/sjph-2021-0007. [DOI] [PMC free article] [PubMed] [Google Scholar]
  37. Roenneberg, T. , Wirz‐Justice A., and Merrow M.. 2003. “Life Between Clocks: Daily Temporal Patterns of Human Chronotypes.” Journal of Biological Rhythms 18, no. 1: 80–90. 10.1177/0748730402239679. [DOI] [PubMed] [Google Scholar]
  38. Romo‐Nava, F. , Blom T., Cuellar‐Barboza A. B., et al. 2021. “Revisiting the Bipolar Disorder With Migraine Phenotype: Clinical Features and Comorbidity.” Journal of Affective Disorders 295: 156–162. 10.1016/j.jad.2021.08.026. [DOI] [PubMed] [Google Scholar]
  39. Saalwirth, C. , and Leipold B.. 2021. “Sleep and Chronotype in Relation to Work‐Related Stress and Negative Affect: The Moderating Role of a Flexible Start of Work.” Somnologie 25, no. 2: 119–125. 10.1007/s11818-021-00294-9. [DOI] [Google Scholar]
  40. Sandoe, C. H. , Sasikumar S., Lay C., and Lawler V.. 2019. “The Impact of Shift Work on Migraine: A Case Series and Narrative Review.” Headache 59, no. 9: 1631–1640. 10.1111/head.13622. [DOI] [PubMed] [Google Scholar]
  41. Sauro, K. M. , and Becker W. J.. 2009. “The Stress and Migraine Interaction.” Headache 49, no. 9: 1378–1386. 10.1111/j.1526-4610.2009.01486.x. [DOI] [PubMed] [Google Scholar]
  42. Sűdy, Á. R. , Ella K., Bódizs R., and Káldi K.. 2019. “Association of Social Jetlag With Sleep Quality and Autonomic Cardiac Control During Sleep in Young Healthy Men.” Frontiers in Neuroscience 13: 950. 10.3389/fnins.2019.00950. [DOI] [PMC free article] [PubMed] [Google Scholar]
  43. Taillard, J. , Sagaspe P., Philip P., and Bioulac S.. 2021. “Sleep Timing, Chronotype and Social Jetlag: Impact on Cognitive Abilities and Psychiatric Disorders.” Biochemical Pharmacology 191: 114438. 10.1016/j.bcp.2021.114438. [DOI] [PubMed] [Google Scholar]
  44. Urbán, R. , Magyaródi T., and Rigó A.. 2011. “Morningness‐Eveningness, Chronotypes and Health‐Impairing Behaviors in Adolescents.” Chronobiology International 28, no. 3: 238–247. 10.3109/07420528.2010.549599. [DOI] [PMC free article] [PubMed] [Google Scholar]
  45. van Oosterhout, W. , van Someren E., Schoonman G. G., et al. 2018. “Chronotypes and Circadian Timing in Migraine.” Cephalalgia: An International Journal of Headache 38, no. 4: 617–625. 10.1177/0333102417698953. [DOI] [PMC free article] [PubMed] [Google Scholar]
  46. Viticchi, G. , Falsetti L., Paolucci M., et al. 2019. “Influence of Chronotype on Migraine Characteristics.” Neurological Sciences: Official Journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology 40, no. 9: 1841–1848. 10.1007/s10072-019-03886-4. [DOI] [PubMed] [Google Scholar]
  47. Wacogne, C. , Lacoste J. P., Guillibert E., Hugues F. C., and Le Jeunne C.. 2003. “Stress, Anxiety, Depression and Migraine.” Cephalalgia: An International Journal of Headache 23, no. 6: 451–455. 10.1046/j.1468-2982.2003.00550.x. [DOI] [PubMed] [Google Scholar]
  48. Wittmann, M. , Dinich J., Merrow M., and Roenneberg T.. 2006. “Social Jetlag: Misalignment of Biological and Social Time.” Chronobiology International 23, no. 1–2: 497–509. 10.1080/07420520500545979. [DOI] [PubMed] [Google Scholar]
  49. Zhang, R. , Cai X., Lin C., et al. 2022. “The Association Between Metabolic Parameters and Evening Chronotype and Social Jetlag in Non‐Shift Workers: A Meta‐Analysis.” Frontiers in Endocrinology 13: 1008820. 10.3389/fendo.2022.1008820. [DOI] [PMC free article] [PubMed] [Google Scholar]

Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Supplementary Materials

Data S1. Supporting Information.

JSR-34-e70066-s001.docx (32.9KB, docx)

Data Availability Statement

For this study, the UK Biobank dataset (application number 71718) was used under standard terms and conditions. Data are available from the UK Biobank–for detailed information, see: https://www.ukbiobank.ac.uk/.

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