Chronotype in migraine and tension-type headache: A population study

This study was designed to examine the distribution of chronotypes among individuals with migraine and tension-type headache and to evaluate the association between chronotype and clinical headache characteristics in a population-based sample.

Although previous research has demonstrated associations between chronotype and migraine, there is limited population-level evidence regarding its relationship with tension-type headache or clinical features of these headache disorders.

We conducted a cross-sectional analysis using baseline data from a nationwide population-based survey, conducted in the Republic of Korea in October 2020, which involved adults 20-59 years old. The chronotype was assessed using the Morningness-Eveningness Questionnaire and categorized into morning (score >58), intermediate (score 41-58), and evening (score <41) chronotypes.

Among 2838 participants, the evening chronotype was more prevalent in the migraine (58 of 160, 36.3%) and tension-type headache (225 of 890, 25.3%) groups than in the nonheadache control group (185 of 1005, 18.4%, p < 0.001). Among participants with migraine, depression (Patient Health Questionnaire-9) and anxiety (Generalized Anxiety Disorder-7) differed across chronotypes in the overall comparison (p = 0.035 and p = 0.047, respectively), with the morning type showing lower levels than those shown by the intermediate and evening types; however, no pairwise differences were statistically significant in the post hoc analyses. Among participants with tension-type headache, depression and anxiety differed across chronotypes in the overall comparison (Patient Health Questionnaire-9, p < 0.001 and Generalized Anxiety Disorder-7, p = 0.006), which was driven by higher levels in the evening type than in both the morning and intermediate types; however, the morning and intermediate types did not differ. In participants with migraine, a higher Morningness-Eveningness Questionnaire score (greater morningness) was marginally associated with more severe headache days per 30 days (p = 0.046), whereas no significant association was found in those with tension-type headache (p = 0.126). Headache days per 30 days, crystal-clear days per 30 days, headache intensity (Visual Analog Scale), and the impact of headache (Headache Impact Test-6) were not significantly associated with Morningness-Eveningness Questionnaire scores in participants with migraine or tension-type headache.

Participants with migraine and tension-type headache showed a significantly higher prevalence of evening chronotype compared with the nonheadache controls. However, greater morningness was associated with more severe headache days in the migraine group but not in the tension-type headache group.