The acute effect of night work-related circadian misalignment on headache episodes: Results from the 1001 nights-cohort

Abstract

Objectives: We aimed to investigate the prevalence of headaches on days with night shifts compared with days with day shifts within the same individuals, accounting for work-related psychosocial stressors, physical job demands, and sleep duration and quality. This approach allowed us to isolate the impact of circadian misalignment due to night work from other potential headache triggers.

Background: Night work has been suggested to increase the risk of headaches, primarily due to circadian misalignment and disturbed sleep. Most previous studies compare night workers with day workers, but differences in job characteristics and tasks between these groups may introduce bias. To minimize this potential bias, we examined headache occurrence under different working conditions (night vs. day shifts) within the same individuals.

Methods: We used data from 14 days of repeated measurements in the 1001 nights-cohort, which includes female employees from the Danish hospital sector. Data were collected from September 2022 to April 2024. Participants completed diaries for 14 consecutive days, providing daily information on working hours, sleep, work-related psychosocial stressors, physical job demands, and headache occurrence (yes/no). Participants with data from at least one day shift and at least one night shift were eligible for inclusion in the analyses. In total, 522 participants contributed 3348 measurement days (1926 day shifts and 1422 night shifts). We estimated prevalence ratios (PRs) for headache occurrence while accounting for repeated measures within individuals and with adjustment for possible confounders (adjusted prevalence ratio [aPR]).

Results: Headache was reported on 21.5% of measurement days with day shifts and on 27.9% of measurement days with night shifts. Working a night shift was associated with a significantly higher headache prevalence (aPR, 1.31; 95% confidence interval, 1.13-1.52) compared with day shifts when adjusting for work-related psychosocial stressors, physical job demands, and sleep duration and quality. For consecutive night shifts, the similarly adjusted headache prevalence was highest on the measurement day with the second night shift (aPR, 1.20; 95% confidence interval, 1.02-1.42), using the first night shift as a reference.

Conclusion: This study is the first to investigate the headache prevalence when working night shifts compared with day shifts while accounting for work-related psychosocial stressors and physical job demands. Neither these factors, nor shorter sleep duration or lower sleep quality, explained the increased headache prevalence observed when participants worked night shifts. Thus, other (cascading) effects and underlying mechanisms of night work-related circadian misalignment may be the primary drivers of headache in night shift workers.

Keywords: healthcare; migraine; occupation; rotating shifts; shift work.