Weekend headache in migraine - fact or fiction? An observational study from DMKG-app data

BackgroundIt has long been proposed that some individuals with migraine are especially prone to experience headache on weekends, however, results have been contradictory. Electronic headache diaries offer the possibility to analyze this question more thoroughly in larger populations.MethodsTwo non-overlapping samples of individuals with migraine from the DMKG-App electronic headache diary were investigated. Cluster analysis and logistic regression were performed to study existence, prevalence and predictive factors of weekend headache.ResultsWe included 1793 and 5840 patients with ≥35 headache day entries in the two samples ("registry sample" and "app-only sample"), respectively. In both samples, cluster analysis identified a cluster of patients with headache occurring preferably on weekends, accounting for 14-15% of all patients, and 18% of individuals with episodic migraine. Compared to the three other clusters identified (an early week cluster, a midweek cluster and a flat cluster without preference for a specific day), the weekend cluster was more frequent in working patients (p < 0.001, OR = 3.57 to 3.97) and in patients with lower headache frequencies (p < 0.001, OR = 0.86). A small association with older age (p < 0.001, OR = 1.01) was limited to the app-only sample. Longitudinal analysis showed that headache patterns of single patients were variable over time.ConclusionsResults from two large samples corroborate that there is a subgroup of individuals with migraine prone to weekend headache. Association with working status supports the notion that release from stress could be a trigger factor in these patients, although change in sleep, caffeine and alcohol intake and other factors might also contribute.