The Impact of Shift Work on Migraine: A Case Series and Narrative Review.

Abstract

We present a case report of 2 migraine patients engaged in shift work, followed by a narrative review, to assess whether shift work influences headache-related disability and chronification of migraine. Numerous modifiable factors can lead to chronification of migraine and to higher headache-related disability. These include, among others, obesity, depression, overuse of acute medications, ineffective acute treatments, and stressful life events. Sleep disruptions and disorders are also felt to increase the risk of transitioning from episodic to chronic migraine. We hypothesize that shift work, which by definition leads to atypical or irregular sleep cycles, along with poor quality sleep, is a risk factor for chronification of migraine. We present the case histories of 2 shift workers with migraine as per International Classification of Headache Disorders 3 criteria, seen at a large, busy academic headache center, followed by a narrative review of the literature. Previous literature regarding the relationship between shift work and migraine is sparse and conflicting, with more recent studies suggesting that shift work may be a risk factor for migraine-related disability. In our case series, both patients initially reported severe migraine headache-related disability and both patients had noted a worsening of their headaches after beginning night shift work. Both improved when switched back to day shifts, then worsened upon being put back on night shifts. Their headache patterns finally reverted from chronic to episodic migraine after eliminating night shifts completely and maintaining a good sleep routine. In the 2 cases presented, shift work appeared to be associated with chronification of migraine and higher headache-related disability despite optimal headache management and good patient adherence. A switch to only day shifts promoted transition to an episodic, less disabling pattern of migraine. It is clinically important to take a detailed sleep history in headache patients, and when appropriate, provide support for workplace accommodations. Further larger-scale, rigorous studies are needed to more clearly delineate the relationship between shift work and migraine.