{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T12:46:51Z","timestamp":1780318011781,"version":"3.54.1"},"reference-count":29,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2020,11,25]],"date-time":"2020-11-25T00:00:00Z","timestamp":1606262400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["headachejournal.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Headache"],"published-print":{"date-parts":[[2021,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To determine whether high school start time is associated with headache frequency in adolescents with migraine.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Adolescence is marked by a physiologic delayed circadian phase, characterized by later bedtimes and wake times. The American Academy of Pediatrics (AAP) recommends that high schools start no earlier than 8:30\u00a0a.m., but most high schools in the United States start earlier. The study hypothesis was that adolescents with migraine whose high schools start at 8:30\u00a0a.m. or later (late group) would have lower headache frequency than those whose schools start earlier than 8:30\u00a0a.m. (early group).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This was a cross\u2010sectional Internet survey study of US high schoolers with migraine recruited online through social media. Comparisons were made between the late group and the early group. The primary outcome measure was self\u2010reported headache days\/month.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      In total, 1012 respondents constituted the analytic set:\n                      <jats:italic>n<\/jats:italic>\n                      \u00a0=\u00a0503 in the late group versus\n                      <jats:italic>n<\/jats:italic>\n                      \u00a0=\u00a0509 in the early group. Mean (SD) self\u2010reported headache days\/month was 4.8 (4.6) versus 7.7 (6.1) in the late and early groups, respectively (\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a00.001); mean difference \u22122.9 (95% CI \u22122.2 to \u22123.6). Mean (SD) self\u2010reported hours of sleep on a school night was 7.9 (0.9) versus 6.9 (1.3),\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a00.001. Adjusting for total hours of sleep, sex, taking a migraine preventive, days of acute medication use, hours of homework, grade level, and missing breakfast, mean (SD) self\u2010reported headache days\/month remained lower in the late group than in the early group: 5.8 (95% CI 5.3\u20136.2) versus 7.1 (95% CI 6.7\u20137.4), (\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a00.001); mean difference \u22121.3 (95% CI \u22121.9 to \u22120.7).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Adolescents with migraine who attend high schools that follow AAP recommendations for start times have lower self\u2010reported headache frequency than those whose high schools start before 8:30\u00a0a.m. If prospective studies confirm this finding, shifting to a later high school start time may be an effective strategy for\u00a0migraine prevention in adolescents.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/head.14016","type":"journal-article","created":{"date-parts":[[2020,11,25]],"date-time":"2020-11-25T10:57:08Z","timestamp":1606301828000},"page":"343-350","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":15,"title":["Later high school start time is associated with lower migraine frequency in adolescents"],"prefix":"10.1111","volume":"61","author":[{"given":"Amy A.","family":"Gelfand","sequence":"first","affiliation":[{"name":"Child &amp; Adolescent Headache Program University of California, San Francisco San Francisco CA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6822-3118","authenticated-orcid":false,"given":"Sara","family":"Pavitt","sequence":"additional","affiliation":[{"name":"Child &amp; Adolescent Headache Program University of California, San Francisco San Francisco CA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandra C.","family":"Ross","sequence":"additional","affiliation":[{"name":"Child &amp; Adolescent Headache Program University of California, San Francisco San Francisco CA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christina L.","family":"Szperka","sequence":"additional","affiliation":[{"name":"Division of Neurology Children\u2019s Hospital of Philadelphia &amp; Department of Neurology Perelman School of Medicine at the University of Pennsylvania Philadelphia PA USA"},{"name":"Division of Neurology Children\u2019s Hospital of Philadelphia &amp; Department of Pediatrics Perelman School of Medicine at the University of Pennsylvania Philadelphia PA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6564-7986","authenticated-orcid":false,"given":"Samantha L.","family":"Irwin","sequence":"additional","affiliation":[{"name":"Child &amp; Adolescent Headache Program University of California, San Francisco San Francisco CA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suzanne","family":"Bertisch","sequence":"additional","affiliation":[{"name":"Division of Sleep and Circadian Disorders Department of Medicine Brigham and Women\u2019s Hospital Harvard Medical School Boston MA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katie L.","family":"Stone","sequence":"additional","affiliation":[{"name":"Department of Epidemiology &amp; Biostatistics University of California, San Francisco San Francisco CA USA"},{"name":"Research Institute California Pacific Medical Center San Francisco CA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Remi","family":"Frazier","sequence":"additional","affiliation":[{"name":"Academic Research Systems University of California, San Francisco San Francisco CA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Barbara","family":"Grimes","sequence":"additional","affiliation":[{"name":"Department of Epidemiology &amp; Biostatistics University of California, San Francisco San Francisco CA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"I. 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