Time preference of headache attack and chronotype in migraine and tension-type headache

Migraine attacks have a time preference of headache attack (TPHA). Chronotype is the propensity for an individual to sleep at a particular time during a 24-h period. However, limited evidence exists regarding the association between TPHA and chronotype in individuals with migraine or tension-type headache (TTH). The aim of the present study is to investigate TPHA and chronotype in individuals with migraine and TTH, which are two of the most common primary headaches. One hundred sixty-nine first-visit migraine and TTH participants were consecutively enrolled. Information on sleep onset time and wake up time on workdays and free days, and TPHA were investigated with a face-to-face interview using a questionnaire booklet. Chronotype was assessed, using the midpoint of sleep on free days, corrected for sleep extension on free days (MSFsc), by subtracting one-half of the average weekly sleep duration. Headache frequency per month, headache intensity, impact of headache, sleep quality, daytime sleepiness, insomnia severity, and mood status were also assessed. Time preference of headache attack was reported for 45.5% and 44.8% of participants with migraine and TTH, respectively. Migraineurs with TPHA had an earlier MSFsc than did migraineurs without TPHA (1:18 a.m. +/- 282 min vs. 4:18 a.m. +/- 186 min; p = .022). Among migraineurs with TPHA, a later MSFsc was associated with a later preferential time of attack (beta = 1.3, 95% confidence interval [CI] = 0.6-2.1, p = .004). A later MSFsc was significantly correlated with a higher headache frequency per month among migraineurs with TPHA (beta = 1.9, 95% CI = 0.3-3.4, p = .023), but was not significantly correlated among migraineurs without TPHA (beta = 1.4, 95% CI -1.7-4.4, p = .332). Among TTH participants with TPHA, MSFsc was not significantly associated with a preferential time of attack (beta = -0.2, 95% CI = -1.0 to 0.6, p = .611). Headache frequency was not associated with MSFsc among TTH participants with TPHA (beta = 0.2, 95% CI = -1.2 to 1.6, p = .792) or among TTH participants without TPHA (beta = 0.4, 95% CI = -0.5 to 1.3, p = .354). In conclusion, approximately one-half of participants with migraine and TTH reported having TPHA. Migraineurs with TPHA had an earlier chronotype than did migraineurs without TPHA. A later chronotype was associated with increased headache frequency and a later time of attack among migraineurs with TPHA. Among participants with TTH, TPHA and headache frequency were not significantly associated with chronotype.