{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T17:27:32Z","timestamp":1787592452458,"version":"build-2736575974"},"reference-count":42,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2026,5,15]],"date-time":"2026-05-15T00:00:00Z","timestamp":1778803200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000065","name":"National Institute of Neurological Disorders and Stroke","doi-asserted-by":"publisher","award":["K12NS130673"],"award-info":[{"award-number":["K12NS130673"]}],"id":[{"id":"10.13039\/100000065","id-type":"DOI","asserted-by":"publisher"}]},{"award":["K12NS130673"],"award-info":[{"award-number":["K12NS130673"]}],"id":[{"id":"https:\/\/ror.org\/01s5ya894","id-type":"ROR","asserted-by":"publisher"}]},{"name":"Gottesman Fund"},{"name":"Clinical and Translational Science Awards","award":["UL1TR004419"],"award-info":[{"award-number":["UL1TR004419"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: The aim of this pilot study was to evaluate the feasibility of developing individualized machine learning models using nocturnal wearable-derived autonomic nervous system (ANS) and sleep metrics to predict next-day headache risk in patients with migraine. We also examined the associations between nocturnal ANS and sleep measures and patient-reported outcome measures (PROMs) related to nociplastic pain, migraine burden, and non-restorative sleep (NRS). Methods: Adults with migraine wore the wrist-worn Empatica EmbracePlus\u00ae wearable during sleep and completed daily headache diaries for approximately 4 weeks (N = 10). Participants also completed daily headache diaries and PROMs assessing nociplastic pain, migraine burden, and non-restorative sleep. Personalized machine learning (ML) models were developed to predict next-day headache using nocturnal ANS activity (e.g., pulse rate variability (PRV), electrodermal activity (EDA), respiratory rate (RR)) and sleep metrics (e.g., interruptions, duration, awakenings). Model performance was evaluated using area under the receiver operating characteristic and precision\u2013recall curves (AUROC, AUPRC), sensitivity, specificity, accuracy, and precision. Spearman correlations assessed the relationship between wearable-derived metrics and patient-reported outcome measurements of sleep quality (PROMIS-Fatigue, PROMIS-Sleep Disturbance) and a surrogate marker of nociplastic pain (Fibromyalgia (FM) Score). Results: 9 out of 10 participants wore the EmbracePlus device for at least the target duration of four weeks. For the next-day headache prediction, model performance varied between individuals; area under the ROC curve (AUROC) ranged from 28.2% to 81.2%. Nocturnal measures of EDA were strongly correlated with the FM score (Spearman\u2019s rho = 0.72\u20130.75, p &lt; 0.05). Conclusions: Phasic EDA may warrant further investigation as a potential physiological indicator related to nociplastic pain mechanisms and next-day headache. However, these findings are preliminary, and larger multicenter trials are needed to confirm results of this pilot study.<\/jats:p>","DOI":"10.3390\/jcm15103802","type":"journal-article","created":{"date-parts":[[2026,5,15]],"date-time":"2026-05-15T08:50:12Z","timestamp":1778835012000},"page":"3802","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Wearable Nocturnal Autonomic and Sleep Biomarkers for Predicting Next-Day Headache and Identifying Nociplastic Pain in Patients with Migraine"],"prefix":"10.3390","volume":"15","author":[{"given":"Lewis E.","family":"Tomalin","sequence":"first","affiliation":[{"name":"Department of Population Health and Science Policy, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin R.","family":"Kummer","sequence":"additional","affiliation":[{"name":"Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA"},{"name":"Windreich Department of Artificial Intelligence and Human Health, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA"},{"name":"Clinical Neuroinformatics Center, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3760-8741","authenticated-orcid":false,"given":"Maya C.","family":"Campbell","sequence":"additional","affiliation":[{"name":"Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA"},{"name":"David S. and Ruth L. Gottesman Center for Headache Treatment and Translational Research, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Asala","family":"Erekat","sequence":"additional","affiliation":[{"name":"Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA"},{"name":"Clinical Neuroinformatics Center, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Wandner","sequence":"additional","affiliation":[{"name":"David S. and Ruth L. Gottesman Center for Headache Treatment and Translational Research, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fred","family":"Cohen","sequence":"additional","affiliation":[{"name":"David S. and Ruth L. Gottesman Center for Headache Treatment and Translational Research, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Clauw","sequence":"additional","affiliation":[{"name":"Chronic Pain and Fatigue Research Center, Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI 48109, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9397-8873","authenticated-orcid":false,"given":"Jessica","family":"Robinson-Papp","sequence":"additional","affiliation":[{"name":"Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4554-3343","authenticated-orcid":false,"given":"Bridget R.","family":"Mueller","sequence":"additional","affiliation":[{"name":"Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA"},{"name":"David S. and Ruth L. Gottesman Center for Headache Treatment and Translational Research, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,5,15]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1111\/head.14024","article-title":"The prevalence and impact of migraine and severe headache in the United States: Updated age, sex, and socioeconomic-specific estimates from government health surveys","volume":"61","author":"Burch","year":"2021","journal-title":"Headache"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"549","DOI":"10.1016\/j.ncl.2025.04.005","article-title":"Advances in Our Understanding and Treatment of Nociplastic Pain","volume":"43","author":"Mueller","year":"2025","journal-title":"Neurol. Clin."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"2673","DOI":"10.2147\/JPR.S329280","article-title":"Central Sensitization in Migraine: A Narrative Review","volume":"15","author":"Suzuki","year":"2022","journal-title":"J. Pain. Res."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"236","DOI":"10.3949\/ccjm.92a.24101","article-title":"Nociplastic pain: A practical guide to chronic pain management in the primary care setting","volume":"92","author":"Thapa","year":"2025","journal-title":"Cleve Clin. J. Med."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1111\/j.1526-4610.2004.04011.x","article-title":"Migraine: A chronic sympathetic nervous system disorder","volume":"44","author":"Peroutka","year":"2004","journal-title":"Headache"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"447","DOI":"10.1016\/S0140-6736(77)91942-0","article-title":"Early morning migraine. Nocturnal plasma levels of catecholamines, tryptophan, glucose, and free fatty acids and sleep encephalographs","volume":"1","author":"Hsu","year":"1977","journal-title":"Lancet"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"191","DOI":"10.1007\/s10286-025-01176-y","article-title":"Beyond the headache: Autonomic reflex dysfunction and heightened sensory sensitivity contribute to orthostatic intolerance in migraine","volume":"36","author":"Mueller","year":"2026","journal-title":"Clin. Auton. Res."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Ablin, J.N. (2024). Nociplastic Pain: A Critical Paradigm for Multidisciplinary Recognition and Management. J. Clin. Med., 13.","DOI":"10.3390\/jcm13195741"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1007\/s11916-018-0671-y","article-title":"Migraine and Autonomic Dysfunction: Which Is the Horse and Which Is the Jockey?","volume":"22","author":"Miglis","year":"2018","journal-title":"Curr. Pain. Headache Rep."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Zhang, L., Qiu, S., Zhao, C., Wang, P., and Yu, S. (2021). Heart Rate Variability Analysis in Episodic Migraine: A Cross-Sectional Study. Front. Neurol., 12.","DOI":"10.3389\/fneur.2021.647092"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"767","DOI":"10.1007\/s11916-022-01079-x","article-title":"The Role of the Autonomic Nervous System in Headache: Biomarkers and Treatment","volume":"26","author":"Gevirtz","year":"2022","journal-title":"Curr. Pain. Headache Rep."},{"key":"ref_12","first-page":"e87282","article-title":"The Correlation Between Migraine Frequency and Sleep Disturbances in Adults: A Cross-Sectional Study","volume":"17","author":"Ikram","year":"2025","journal-title":"Cureus"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1074","DOI":"10.1111\/head.13357","article-title":"Sleep and Migraine: Assessment and Treatment of Comorbid Sleep Disorders","volume":"58","author":"Rains","year":"2018","journal-title":"Headache"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"126","DOI":"10.1186\/s10194-020-01192-5","article-title":"Migraine and sleep disorders: A systematic review","volume":"21","author":"Tiseo","year":"2020","journal-title":"J. Headache Pain."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"3331024251391207","DOI":"10.1177\/03331024251391207","article-title":"The promise of machine learning in predicting migraine attacks","volume":"45","author":"Dumkrieger","year":"2025","journal-title":"Cephalalgia"},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Connelly, M., Boorigie, M., and McCabe, K. (2023). Acceptability and Tolerability of Extended Reality Relaxation Training with and without Wearable Neurofeedback in Pediatric Migraine. Children, 10.","DOI":"10.3390\/children10020329"},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Kapustynska, V., Abromavicius, V., Serackis, A., Paulikas, S., Ryliskiene, K., and Andruskevicius, S. (2024). Machine Learning and Wearable Technology: Monitoring Changes in Biomedical Signal Patterns during Pre-Migraine Nights. Healthcare, 12.","DOI":"10.3390\/healthcare12171701"},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Siirtola, P., Koskimaki, H., Monttinen, H., and Roning, J. (2018). Using Sleep Time Data from Wearable Sensors for Early Detection of Migraine Attacks. Sensors, 18.","DOI":"10.3390\/s18051374"},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Headache Classification Committee of the International Headache Society (IHS) (2018). The International Classification of Headache Disorders, 3rd edition. Cephalalgia, 38, 1\u2013211.","DOI":"10.1177\/0333102417738202"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1186\/s10194-024-01937-6","article-title":"Consistency between headache diagnoses and ICHD-3 criteria across different levels of care","volume":"26","author":"Overeem","year":"2025","journal-title":"J. Headache Pain."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"155","DOI":"10.4103\/jmss.JMSS_78_20","article-title":"Electrodermal Activity for Measuring Cognitive and Emotional Stress Level","volume":"12","author":"Rahma","year":"2022","journal-title":"J. Med. Signals Sens."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"02TR01","DOI":"10.1088\/1361-6579\/ac5007","article-title":"Current trends and opportunities in the methodology of electrodermal activity measurement","volume":"43","author":"Tronstad","year":"2022","journal-title":"Physiol. Meas."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"52","DOI":"10.1016\/j.ijpsycho.2021.08.003","article-title":"Validity of electrodermal activity-based measures of sympathetic nervous system activity from a wrist-worn device","volume":"168","author":"Gevonden","year":"2021","journal-title":"Int. J. Psychophysiol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"400","DOI":"10.1080\/07420528.2020.1835942","article-title":"Sleep assessment by means of a wrist actigraphy-based algorithm: Agreement with polysomnography in an ambulatory study on older adults","volume":"38","author":"Regalia","year":"2021","journal-title":"Chronobiol. Int."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1885","DOI":"10.1007\/s11136-018-1842-3","article-title":"PROMIS((R))-29 v2.0 profile physical and mental health summary scores","volume":"27","author":"Hays","year":"2018","journal-title":"Qual. Life Res."},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Wolfe, F., Clauw, D.J., Fitzcharles, M.-A., Goldenberg, D.L., H\u00e4user, W., Katz, R.L., Mease, P.J., Russell, A.S., Russell, I.J., and Walitt, B. (2016). 2016 Revisions to the 2010\/2011 fibromyalgia diagnostic criteria. Seminars in Arthritis and Rheumatism, Elsevier.","DOI":"10.1016\/j.semarthrit.2016.08.012"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1113","DOI":"10.3899\/jrheum.100594","article-title":"Fibromyalgia criteria and severity scales for clinical and epidemiological studies: A modification of the ACR Preliminary Diagnostic Criteria for Fibromyalgia","volume":"38","author":"Wolfe","year":"2011","journal-title":"J. Rheumatol."},{"key":"ref_28","first-page":"2502","article-title":"Quantitative autonomic testing","volume":"53","author":"Novak","year":"2011","journal-title":"J. Vis. Exp."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"e70050","DOI":"10.1002\/jaba.70050","article-title":"Using wearable technology to evaluate the electrodermal activity of therapists assessing challenging behavior","volume":"59","author":"Sullivan","year":"2026","journal-title":"J. Appl. Behav. Anal."},{"key":"ref_30","unstructured":"Braithwaite, J.J., Watson, D.G., Jones, R., and Rowe, M. (2013). A Guide for Analysing Electrodermal Activity (EDA) & Skin Conductance Responses (SCRs) for Psychological Experiments, University of Birmingham."},{"key":"ref_31","first-page":"777","article-title":"Toward a taxonomy of autonomic sleep patterns with electrodermal activity","volume":"Volume 2011","author":"Sano","year":"2011","journal-title":"Proceedings of the 2011 Annual International Conference of the IEEE Engineering in Medicine and Biology Society"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"726","DOI":"10.1016\/j.apmr.2026.01.006","article-title":"Getting to Know Pain Effect Sizes-Guidelines for Effect Size and Sample Size in Global Pain Research","volume":"107","author":"Zielinski","year":"2026","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"3331024231169244","DOI":"10.1177\/03331024231169244","article-title":"Forecasting migraine with machine learning based on mobile phone diary and wearable data","volume":"43","author":"Stubberud","year":"2023","journal-title":"Cephalalgia"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"996","DOI":"10.1212\/CON.0000000000000624","article-title":"The Migraine Premonitory Phase","volume":"24","author":"Karsan","year":"2018","journal-title":"Continuum"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"232","DOI":"10.1093\/brain\/awt320","article-title":"Brain activations in the premonitory phase of nitroglycerin-triggered migraine attacks","volume":"137","author":"Maniyar","year":"2014","journal-title":"Brain"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"253","DOI":"10.1111\/head.14069","article-title":"Systematic review of outcomes and endpoints in preventive migraine clinical trials","volume":"61","author":"McGinley","year":"2021","journal-title":"Headache"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1038\/s41598-021-03997-z","article-title":"Mortality associated with nonrestorative short sleep or nonrestorative long time-in-bed in middle-aged and older adults","volume":"12","author":"Yoshiike","year":"2022","journal-title":"Sci. Rep."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"101771","DOI":"10.1016\/j.smrv.2023.101771","article-title":"Objective sleep measures in chronic fatigue syndrome patients: A systematic review and meta-analysis","volume":"69","author":"Mohamed","year":"2023","journal-title":"Sleep. Med. Rev."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"e1620","DOI":"10.1212\/WNL.0000000000012701","article-title":"Subjective Sleep Quality and Sleep Architecture in Patients With Migraine: A Meta-analysis","volume":"97","author":"Stanyer","year":"2021","journal-title":"Neurology"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1030","DOI":"10.1111\/head.13358","article-title":"Sleep Disorders and Migraine: Review of Literature and Potential Pathophysiology Mechanisms","volume":"58","author":"Vgontzas","year":"2018","journal-title":"Headache"},{"key":"ref_41","first-page":"4289","article-title":"Comparison of heart rate variability signal features derived from electrocardiography and photoplethysmography in healthy individuals","volume":"Volume 2006","author":"Bolanos","year":"2006","journal-title":"Proceedings of the 2006 International Conference of the IEEE Engineering in Medicine and Biology Society"},{"key":"ref_42","doi-asserted-by":"crossref","unstructured":"Nardelli, M., Vanello, N., Galperti, G., Greco, A., and Scilingo, E.P. (2020). Assessing the Quality of Heart Rate Variability Estimated from Wrist and Finger PPG: A Novel Approach Based on Cross-Mapping Method. Sensors, 20.","DOI":"10.3390\/s20113156"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/10\/3802\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,15]],"date-time":"2026-05-15T09:22:41Z","timestamp":1778836961000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/10\/3802"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,15]]},"references-count":42,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2026,5]]}},"alternative-id":["jcm15103802"],"URL":"https:\/\/doi.org\/10.3390\/jcm15103802","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,15]]}}}