Does being a night owl in migraine have any connection to higher migraine-related disability?

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Erkan Acar¹, Zeynep Özdemir², Pınar Yalınay Dikmen¹ This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6768112/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: Emerging evidence suggests circadian rhythms may influence migraine pathophysiology. This study investigates the association between chronotype and migraine-related disability. Methods: In this cross-sectional study, 200 migraine patients and 134 controls completed the Pittsburgh Sleep Quality Index (PSQI), Morningness-Eveningness Questionnaire (MEQ), and Migraine Disability Assessment Scale (MIDAS). Results: Migraine patients exhibited poorer sleep quality (PSQI: 7.28 vs. 4.37, p<0.001), with chronic migraine (CM) patients showing the highest disability (MIDAS: 36.17 vs. 9.63, p<0.001). No significant difference in chronotype distribution was observed between groups (p=0.48). Morning chronotypes had lower MIDAS scores (16.95±16.17) compared to intermediate (23.93±22.28) and evening types (23.55±20.85), though differences were non-significant (p=0.082). Conclusions: While chronotype does not directly correlate with migraine-related disability, poor sleep quality in migraine patients, particularly those with CM, underscores the need for sleep-focused interventions. migraine circadian migraine-related disability morningness eveningness Introduction Circadian rhythms which measure time on a scale of 24 hours are organized by an internal biological clock and are believed to be generated by the suprachiasmatic nucleus (SCN) of the hypothalamus [ 1 ] [ 2 ]. These rhythms include body temperature, various hormone levels, the number of immune cells in blood, and the sleep-wake cycle. Chronotype or circadian typology such as morning, intermediate or evening-type has been named as a background variable in the last decades[ 3 ]. According to an individual’s chronotype, some people can be characterized as “early birds or lark” and some people as “night owls”. The early birds wake up early, go to bed early and are more alert in the morning than in the evening. On the other hand, the night owls prefer to wake up later in the day, are more alert at night, and go to bed late. These subjects built up a sleep debt during the week and extended their duration of sleep at a weekend. Migraine is a highly prevalent and disabling disorder accounted among primary headaches as the studies show that migraine is one of the leading causes of impairment worldwide [ 4 ]. Relationship between chronotype and migraine has not been precisely revealed. In 2018, chronotypes and circadian timing in migraine were studied in 2875 patients with migraine and 200 non-headache volunteers. Authors found that patients with migraine had an early chronotype compared to the control group (48.9% vs. 36.8%; p < 0.001). In this study, 40.2% of migraine patients’ attack onset was reported as in early morning. However, Gori et al. [ 5 ] reported that morning and evening types in the migraine group (n = 100) was more common compared to the control group subjects (n = 30). Moreover, 53% of migraine patients’ attack onset was reported as at night. Cevoli et al.[ 6 ] reported that chronotypes distribution in 93 patients with menstrual migraine showed no differences compared with 85 healthy control subjects. Finally Viticchi et al.[ 7 ] assessed chronotypes in migraine patients and possible influences on the clinical expression of migraine (n = 100). Authors reported that chronotypes of migraine patients seemed to influence number and duration of migraine attacks but the intensity of migraine attack was not influenced by chronotypes [ 7 ]. So only a limited number of studies with inconsistent results have published so far. People need to get up early to go to work or school in modern day life routine, so requirements for modern life would be easier for early birds. Besides unsolved chronotypes differences between migraine patients and healthy individuals so far, being an early bird or being a night owl for a patient with migraine may influence a patient’s migraine-related disability. Because sleep disturbances are one of main triggers for migraine [ 8 ]. Disturbed sleep patterns and insufficient sleep may cause an increased frequency of migraine attacks for an early birds with migraine [ 9 ]. In fact that, a higher prevalence of poor sleep quality was reported in patients with migraine [ 10 ] [ 11 ] and also improvement was observed after treatment [ 12 ]. We hypothesized that having a night owl chronotype for migraine patients may influence and may increase their migraine-related disability. In this study, our first aim was to investigate any differences about sleep quality and chronotypes between migraine patients and healthy subjects. Our second aim was to investigate whether being a night owl for migraine patients had a negative effect on their migraine-related disabilities or not. Method This cross-sectional, prospective study included a total of 200 migraine patients who were recruited at the outpatient clinics of Neurology Departments of two hospitals between January 2019 and December 2019. Neurologists established the diagnosis of migraine according to the International Classification of Headache Disorders, third edition (ICHD-III) [ 13 ]. The inclusion criteria for this study were patients between 18–60 years of age with a history of migraine for at least six months and were willing to participate in the study. Patients who presented with a headache of secondary nature, any unstable medical or psychiatric condition, a pregnancy, breastfeeding or night shift workers were excluded. As this study was mainly based on self-assessed questionnaires, illiterate patients were not included. The control group was composed of relatives of patients who underwent a workup at our neurophysiology units for various peripheral disorders. Volunteers were evaluated by neurologist and a diagnosis of migraine or frequent tension-type headache was excluded. They were also excluded according to the exclusion criteria of the study. Two hundred sixty-four patients with migraine and one hundred fifty-four volunteers were invited to study. Two hundred patients who suffered from migraine and 134 healthy subjects agree to participate in this study. Written informed consent was obtained from each subject following a detailed explanation of the study, and all participants were given an informed consent form. The objectives and protocol of the study, which was conducted by the ethical principles stated in the "Declaration of Helsinki," was approved by the Acibadem University Clinical Research Ethics Committee. Study Measures Sociodemographic data form In order to evaluate the sociodemographic characteristics of participants, both migraine patients and healthy subjects were asked to fill out a questionnaire that yielded information on age, sex, educational background, and occupation. Migraine patients were questioned by neurologist about the duration and clinical characteristics of their migraines as well as, family history, presence of comorbidities, precipitating factors, medication overuse, previous use of prophylactic treatment, and current treatments. Migraine Disability Assessment Scale (MIDAS) was recorded by neurologists. All subjects completed Pittsburgh Sleep Quality Index (PSQI) and Morningness-Eveningness Questionnaire (MEQ) to evaluate sleep quality and chronotype assessment of the participants, respectively. PSQI The Pittsburgh Sleep Quality Index (PSQI) is a questionnaire used to evaluate sleep quality during a previous month. It was developed by Buysse et al. [ 14 ]. The Turkish reliability and validation was done by Agargun et al.[ 15 ]. The PSQI questionnaire consists of nineteen self-rated questions, and if available, five questions are rated by the bed partner or roommate. Only self-rated questions are scored and combined to produce seven subcomponent scores; subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbances, use of sleeping medication, and daytime dysfunction. These subcomponents yield one global score that ranges from 0 to 21. A score > 5 is indicated as a poor sleep. Higher scores are related to worse sleep quality. Chronotype assessment: MEQ The MEQ was used to define for the chronotype of people and determine whether their internal clock are more inclined to make them a night person such as a "night owl" or a morning person, a so-called "early bird". The questionnaire was first developed by Horne and Ostberg [ 16 ], and the Turkish reliability and validation study was conducted by Punduk et al. [ 17 ]. It contains 19 questions on sleep habits and fatigue. It categorizes patients into five groups, with the lowest scores associated with eveningness and higher scores with morningness. The scores vary between 16–86. The total score was graded in turn; 16–30 (Definite Evening), 31–41 (Moderate Evening), 42–58 (Intermediate), 59–69 (Moderate Morning) and 70–86 (Definite Morning). MIDAS MIDAS is a questionnaire developed by Stewart et al. [ 18 ] and is composed of 5 questions that determine quantitatively the disability caused by migraine. MIDAS score calculates the sum of missed work or school days, missed household chores days, missed activity days outside the workplace as well as days at work or school plus days of household chores where productivity was reduced by 50% or more in the past three months due to migraine. The Turkish reliability and validation study was done by Ertas et al. [ 19 ]. The total score was graded as follows: grade I (0 to 5 days) little or no disability; grade II (6 to 10 days), mild disability; grade III (11 to 20 days), moderate disability; and grade IV (higher than 21 days), severe disability. Statistics Results A total 200 patients with migraine and 110 healthy volunteers were recruited in the study. Rates of episodic migraine (EM) and chronic migraine in (CM) our study were 53.5% (n = 107) and 46.5% (n = 93), respectively. Table 1 shows demographic features of all participants. Age and job status of two groups were not statistically different; however, female gender (81%) in the migraine group (MG) was higher than the control group (CG) (63.6%). MIDAS scores of MG based on their chronotypes did not show any statistical difference (Table 6 ); however the MIDAS scores were different between intermediate and morning chronotypes of MG (p = 0.014) and the MIDAS-A scores were different between evening and morning chronotypes of MG (p = 0.025). Table 1. Variable All patient Chronic Episodic Control P value Patient Number 200 93 107 110 Female (Gender) N 162 (81%) 76 (81.72%) 86 (80.37%) 70 (63.64%) 0.001* Age (Mean) 34.49 ± 7.92 34.10 ± 7.56 34.84 ± 8.25 34.68 ± 10.63 0.478† Job Status 0.297* Employee ( N) 164 77 87 91 Housewife 20 9 11 5 Student 15 6 9 11 Retire 1 1 0 3 † Wilcoxon Rank test between migraine and control. (Wilcox test for age between episodic and chronic migraine patient had p value as 0.373) * Chi square test between migraine and control. (Distribution of gender among all migraine patients and control, this p < 0.05 indicate that gender and having migraine was not independent. Distribution of gender among episodic and chronic migraine patients had p value as 0.951. Distribution all job status among all migraine and controls, this p > 0.05 indicates that job status and having migraine were independent.) Table 2 demonstrates migraine features and MIDAS scores of all migraine patients as well as subgroups of EM and CM. In this study, 56.5% of the migraine patients had family history of migraine and there was no statistical differences between EM and CM patients. Medication overuse headache (MOH) was reported by 33% of migraine patients. Indeed, MOH was significantly higher in the CM patients (58%) compared to episodic ones (11.2%) (p < 0.001). Mean migraine duration of all patients was 10.70(± 8.01) months and there was no statistical differences between two migraine subgroups (p = 0.303). Mean MIDAS scores of all patients were 21.97 (± 20.75) and it showed higher disability because of migraine. The MIDAS scores of CM and EM patients were 36.17 (± 21.09) and 9.63(± 9.58), respectively and the scores of two groups showed statistical significance (p < 0.001). Headache days for last three months were also highly different between EM and CM subgroups (13.80 vs. 52.89; (p < 0.001). Though the pain intensity for past three months which was reported by participants with EM and CM did not show statistical difference (7.7 vs. 6.96; p = 0.344). Table 2. All Migraine Patients Chronic Episodic p-value Patient Number 200 93 107 Migraine in Family History (1) N 113 51 62 0.765* MOH (1) N 66 54 12 p < 0.001* Migraine Duration (Mean) 10.70 ± 8.01 11.27 ± 8.14 10.21 ± 7.90 0.303** MIDAS score (Mean) 21.97 ± 20.75 36.17 ± 21.09 9.63 ± 9.58 p < 0.001** MIDAS A (Mean) 31.98 ± 27.37 52.89 ± 25.65 13.80 ± 10.86 p < 0.001** MIDAS B (Mean) 7.32 ± 3.62 7.73 ± 5.03 6.96 ± 1.54 0.344** *Chi square test between chronic and episodic migraine patients. (In this study migraine family history was not dependent to having chronic or episodic migraine. Distribution of IKKB and migraine type was dependent and distribution of IKKB different among episodic and chronic migraine patients.) **Wilcoxon Rank test between scores of chronic and episodic migraine patients Table 3 summarizes comparison of total PSQI scores and its subdivisions between the MG and the CG as well as two migraine subgroups. The sleep quality of CG was not poor (4.37). However, total scores of the patients showed poor sleep quality (7.28). The PSQI scores of CM and EM groups were 8.24 and 6.45, respectively (p = 0.008). Comparison of the PSQI scores in the both CM (8.24) and EM (6.45) showed statistical significant difference with the CG (4.37) (p < 0.001). The subdivisions of PSQI scores (subjective sleep quality, sleep latency, sleep duration, habitual sleep deficiency, sleep disturbances, sleep medicine usage, daytime dysfunction) showed statistical differences between the MG and the CG. Episodic migraine and CM patients also had differences between sleep disturbances subdivision. Comparison of patients with CM and CG showed higher number of differences for all PSQI subdivisions between two groups. The sleep latency, sleep duration and usage of sleeping medicine subdivisions of the PSQI between patients with EM and CG did not show any statistical difference. Habitual sleep deficiency, sleep disturbances and usage of sleeping medicine subdivisions showed statistical difference between CM and EM groups. Table 3. PSQI All patients Chronic Episodic Control PSQI total score 7.28 ± 4.17 8.24 ± 4.45 6.45 ± 3.74 4.37 ± 1.73 Subjective Sleep Quality (C1) 1.35 ± 0.71 1.45 ± 0.71 1.26 ± 0.70 0.94 ± 0.47 Sleep latency (C2) 1.27 ± 0.96 1.37 ± 0.94 1.19 ± 0.97 0.86 ± 0.80 Sleep Duration (C3) 0.92 ± 0.99 1.05 ± 1.01 0.81 ± 0.96 0.49 ± 0.71 Habitual Sleep Deficiency (C4) 0.72 ± 1.02 0.87 ± 1.09 0.60 ± 0.94 0.19 ± 0.48 Sleep Disturbances (C5) 1.48 ± 0.74 1.69 ± 0.77 1.29 ± 0.66 1.08 ± 0.45 Use Sleeping Med (C6) 0.31 ± 0.82 0.47 ± 1.03 0.17 ± 0.56 0.05 ± 0.27 Daytime dysfunction (C7) 1.23 ± 0.93 1.33 ± 0.97 1.13 ± 0.89 0.76 ± 0.69 Table 4 shows chronotypes of MG and CG based on the MEQ scores and there was no statistical differences between two groups (p = 0.48). Intermediate sleep chronotypes was the most common one in both the migraine and control groups (61.5% vs 54.5%). These results was consistent with patients for the CM and the EM (p = 0.140). Morning, intermediate and evening chronotypes in MG and CG were (n = 55, 27.5% vs. n = 35, 31.8%), (n = 123, 61.5% vs. n = 60, 54.5%) and (n = 22, 11% vs. n = 15, 13.7%), respectively (p = 0.48). A distribution of three chronotypes in EM group was morning (n = 35, 32.7%), intermediate (n = 63, 58.9%) and evening (n = 9, 8.4%). A distribution of three phenotypes in CM group was morning (n = 20, 21.5%), intermediate (n = 60, 64.5%) and evening (n = 13, 14%). Rates of three chronotypes in EM and CM groups did not statistically different (p = 0.140). Table 4. Evening Intermediate Morning Migraine N(%) 22 (11%) 123 (61.5%) 55 (27.5%) Control N(%) 15 (13.67%) 60 (54.55%) 35 (31.82%) P value* 0.484* *Chi square test for distribution of sleeping types between migraine and control groups. Table 5 demonstrates the total PSQI scores and the subdivisions of PSQI in three chronotypes of the MG. Post hoc analysis which was done for if only significant p values available among three chronotypes of MG patients. Total PSQI scores and subjective sleep quality, sleep latency, sleep disturbances and daytime dysfunction subdivisions showed statistically better results in morning chronotype group. Table 5. Sleep Parameter Evening Intermediate Morning P value* Subjective Sleep Quality (C1) 1.45 ± 0.59 1.43 ± 0.71 1.13 ± 0.72 0.026* Sleep latency (C2) 1.32 ± 0.99 1.45 ± 0.95 0.85 ± 0.85 < 0.001** Sleep Duration (C3) 0.95 ± 1.04 0.97 ± 0.99 0.82 ± 0.98 0.558 Habitual Sleep Deficiency (C4) 0.54 ± 1.10 0.79 ± 1.03 0.65 ± 0.97 0.232 Sleep Disturbances (C5) 1.50 ± 0.86 1.56 ± 0.70 1.28 ± 0.73 0.044* Use Sleeping Med (C6) 0.37 ± 0.79 0.38 ± 0.91 0.12 ± 0.58 0.066 Daytime dysfunction (C7) 1.55 ± 0.91 1.35 ± 0.94 0.82 ± 0.79 < 0.001** PSQI 7.68 ± 3.98 7.93 ± 4.14 5.67 ± 3.95 0.002** Table 6. Evening Intermediate Morning Activity Score Chronic N(%) 13 (13.98%) 60 (64.52%) 20 (21.5%) 50.85 ± 9.02 Episodic N(%) 9 (8.41%) 63 (58.88%) 35 (32.71%) 53.80 ± 9.25 P value 0.140 * 0.023** *Chi square test between episodic and chronic migraine groups. **Welch Two Sample t-test between chronic and episodic patients’ activity scores. Table 7. Evening Intermediate Morning P value* MIDAS 23.55 ± 20.85 23.93 ± 22.28 16.95 ± 16.17 0.082 MIDAS A 42.73 ± 31.39 31.74 ± 25.95 28.22 ± 28.17 0.133 MIDAS B 6.95 ± 1.13 7.07 ± 1.50 8.04 ± 6.48 0.681 Discussion In our study, both the migraine group (MG) showed poor sleep quality, with PSQI scores significantly higher in migraine patients. Although episodic migraine (EM) participants and the control group (CG) showed no difference in sleep quality, chronic migraine (CM) patients had the highest PSQI scores and experienced more daytime dysfunction than the CG. This finding suggests that migraine chronicity is associated with increasingly poor sleep quality. Among chronotypes, the intermediate type was the most common in both MG and CG. When comparing total PSQI scores and sub-scores among chronotypes in the MG, morning types demonstrated better sleep quality, shorter sleep latency, and better daytime function than the intermediate and evening types. MIDAS scores were lowest among morning chronotypes. However, no statistically significant difference in migraine-related disability was found among the three chronotypes. As expected, CM patients had higher migraine-related disability and more frequent medication overuse headache (MOH) than EM patients. CM patients also experienced the most severe impact on sleep quality. Our findings align with those of Gori et al.[ 5 ], who found that sleep latency was the most affected sleep aspect in migraine patients. However, our results show that all PSQI sub-scores were worse in MG compared to CG, with CM patients experiencing the most severe sleep issues, including increased habitual sleep deficiency, sleep disturbances, and sleep medication use. Comparison of sleep issues in EM and CM patients indicated that habitual sleep deficiency, sleep disturbances, and medication use were most common in CM patients. Sleep disturbances and medication use, in particular, were the most frequently affected aspects of sleep among all migraine patients, likely contributing to daytime dysfunction in the CM group. In contrast to the findings by Van Oosterhout et al.[ 20 ], who reported that early and late chronotypes were more prevalent among migraine patients than in non-headache controls, our results did not show a significant difference in chronotype distribution between MG and CG, with the intermediate type being the most common in both groups. While Van Oosterhout used the Munich Chronotype Questionnaire, we used the Morningness-Eveningness Questionnaire (MEQ), which might account for some of these differences. Cevoli et al., using the MEQ as well, found similar results to ours, with the intermediate type being the most common in migraine patients [ 6 ]. Thus, while there are some variations across studies, the distribution of chronotypes in migraine patients remains an area for further exploration. Our study showed no statistically significant difference in migraine-related disability across the three chronotypes within the MG, although MIDAS scores indicated moderate disability in morning chronotypes and severe disability in intermediate and evening chronotypes. While the difference in MIDAS scores between intermediate and morning chronotypes was statistically significant, differences among other chronotypes were not. Gori et al. reported that morning and evening types had poorer sleep and higher migraine-related disability compared to intermediate types [ 5 ], which was partly consistent with our findings. The findings of Viticchi et al. similarly support the idea that chronotype may influence the frequency and duration of migraine attacks [ 7 ]. Our study has some limitations. First, the MG was predominantly composed of females compared to the CG, which may have influenced our findings. Declarations Acknowledgments The author has no acknowledgments to declare. Author Contributions: Erkan Acar: Conceptualization, Methodology, Formal analysis, Writing – Original Draft, Supervision, Project administration, Correspondence. Zeynep Özdemir: Data curation, Investigation, Patient recruitment, Writing – Review & Editing. Pınar Yalınay Dikmen: Methodology, Validation, Writing – Review & Editing, Supervision. Funding There was no funding. Availability of Data and Materials The datasets produced and/or examined during the present investigation are not accessible to the public but can be obtained from the corresponding author upon a reasonable request. Ethics approval and consent to participate The study was conducted in accordance with the declaration of Helsinki and was approved by the ethics committee of Acibadem Mehmet Ali Aydinlar University approved the study with a reference number of 2019-01/19. Written informed consent was acquired from all the participants at the time of participation. Consent for publication Not applicable. Competing interests The authors declare there is no competing interests. References Gillette MU, Mitchell JW. Signaling in the suprachiasmatic nucleus: Selectively responsive and integrative. Cell Tissue Res. 2002;309:99–107. van Esseveldt LE, Lehman MN, Boer GJ. The suprachiasmatic nucleus and the circadian time-keeping system revisited. Brain Res Rev. 2000;33:34–77. 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Migraine and Sleep—An Unexplained Association? Int J Mol Sci. 2021;22:5539. Kelman L, Rains JC. Headache and sleep: Examination of sleep patterns and complaints in a large clinical sample of migraineurs. Headache. 2005;45:904–10. Seidel S, Hartl T, Weber M, Matterey S, Paul A, Riederer F, et al. Quality of sleep, fatigue and daytime sleepiness in migraine - A controlled study. Cephalalgia. 2009;29:662–9. Sleep quality and depression among patients with migraine - PubMed. https://pubmed.ncbi.nlm.nih.gov/24390948/ . Accessed 3 Jun 2025. Yalinay Dikmen P, Yavuz BG, Aydinlar EI. The relationships between migraine, depression, anxiety, stress, and sleep disturbances. Acta Neurol Belg. 2015;115:117–22. The International Classification of Headache Disorders, 3rd edition, Copyright. https://doi.org/10.1177/0333102417738202 Buysse DJ, Reynolds CF, Monk TH, Berman SR, Kupfer DJ. The Pittsburgh sleep quality index: A new instrument for psychiatric practice and research. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6768112","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":486779910,"identity":"7b1f9eba-c199-4480-a86d-d7b7958733de","order_by":0,"name":"Erkan Acar¹","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA70lEQVRIie3PMQrCMBSA4RcC7RLpqgTsFSIdBT2IS0VwKwguBQcrhbiIc0HQK+jibCno8tADdFE8gougiLHgItQ6OuRf3iPkIwRAp/vLjPdCRudsUhr8SmjoAAg1yc/ElDwjUEAsvm1fetCwrVksBz3/3rLGilz9dS6pTLsJj6BTi/ZtmUYovCghAZlgmksEmgFnQF1AItOSFF6gCFV7LmmiGd4YDF1bkf6LLIqIYMZWvZK4QhH6IssiUkajW2ewq62QhJyh460Uib/9xZoYTspgYFfRPF2YX/XmhyQ+Xv18kkUeHweb7/d1Op1OV9QT5MFP6neEnB8AAAAASUVORK5CYII=","orcid":"","institution":"Acibadem Mehmet Ali Aydinlar University School of Medicine","correspondingAuthor":true,"prefix":"","firstName":"Erkan","middleName":"","lastName":"Acar¹","suffix":""},{"id":486779912,"identity":"50f0b0bf-08c9-4fa8-a893-69505c9514ca","order_by":1,"name":"Zeynep Özdemir²","email":"","orcid":"","institution":"Istanbul Health Sciences University, Bakirkoy Prof. Dr. Mazhar Osman Training and Research Hospital for Psychiatric, Neurologic and Neurosurgical Diseases","correspondingAuthor":false,"prefix":"","firstName":"Zeynep","middleName":"","lastName":"Özdemir²","suffix":""},{"id":486779913,"identity":"19e3856c-790a-42e8-acda-628ab68af753","order_by":2,"name":"Pınar Yalınay Dikmen¹","email":"","orcid":"","institution":"Acibadem Mehmet Ali Aydinlar University School of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Pınar","middleName":"Yalınay","lastName":"Dikmen¹","suffix":""}],"badges":[],"createdAt":"2025-05-28 12:38:07","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6768112/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6768112/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":104401801,"identity":"87f931fa-0e1d-4345-929b-2cb7fc4943f4","added_by":"auto","created_at":"2026-03-11 12:13:35","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":668309,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6768112/v1/afa2d862-f5bc-4dbe-9215-172628c85a44.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Does being a night owl in migraine have any connection to higher migraine-related disability?","fulltext":[{"header":"Introduction","content":"\u003cp\u003eCircadian rhythms which measure time on a scale of 24 hours are organized by an internal biological clock and are believed to be generated by the suprachiasmatic nucleus (SCN) of the hypothalamus [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e] [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. These rhythms include body temperature, various hormone levels, the number of immune cells in blood, and the sleep-wake cycle. Chronotype or circadian typology such as morning, intermediate or evening-type has been named as a background variable in the last decades[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. According to an individual\u0026rsquo;s chronotype, some people can be characterized as \u0026ldquo;early birds or lark\u0026rdquo; and some people as \u0026ldquo;night owls\u0026rdquo;. The early birds wake up early, go to bed early and are more alert in the morning than in the evening. On the other hand, the night owls prefer to wake up later in the day, are more alert at night, and go to bed late. These subjects built up a sleep debt during the week and extended their duration of sleep at a weekend.\u003c/p\u003e\u003cp\u003eMigraine is a highly prevalent and disabling disorder accounted among primary headaches as the studies show that migraine is one of the leading causes of impairment worldwide [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Relationship between chronotype and migraine has not been precisely revealed. In 2018, chronotypes and circadian timing in migraine were studied in 2875 patients with migraine and 200 non-headache volunteers. Authors found that patients with migraine had an early chronotype compared to the control group (48.9% vs. 36.8%; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). In this study, 40.2% of migraine patients\u0026rsquo; attack onset was reported as in early morning. However, Gori et al. [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e] reported that morning and evening types in the migraine group (n\u0026thinsp;=\u0026thinsp;100) was more common compared to the control group subjects (n\u0026thinsp;=\u0026thinsp;30). Moreover, 53% of migraine patients\u0026rsquo; attack onset was reported as at night. Cevoli et al.[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e] reported that chronotypes distribution in 93 patients with menstrual migraine showed no differences compared with 85 healthy control subjects. Finally Viticchi et al.[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e] assessed chronotypes in migraine patients and possible influences on the clinical expression of migraine (n\u0026thinsp;=\u0026thinsp;100). Authors reported that chronotypes of migraine patients seemed to influence number and duration of migraine attacks but the intensity of migraine attack was not influenced by chronotypes [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. So only a limited number of studies with inconsistent results have published so far.\u003c/p\u003e\u003cp\u003ePeople need to get up early to go to work or school in modern day life routine, so requirements for modern life would be easier for early birds. Besides unsolved chronotypes differences between migraine patients and healthy individuals so far, being an early bird or being a night owl for a patient with migraine may influence a patient\u0026rsquo;s migraine-related disability. Because sleep disturbances are one of main triggers for migraine [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Disturbed sleep patterns and insufficient sleep may cause an increased frequency of migraine attacks for an early birds with migraine [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. In fact that, a higher prevalence of poor sleep quality was reported in patients with migraine [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e] [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e] and also improvement was observed after treatment [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. We hypothesized that having a night owl chronotype for migraine patients may influence and may increase their migraine-related disability.\u003c/p\u003e\u003cp\u003eIn this study, our first aim was to investigate any differences about sleep quality and chronotypes between migraine patients and healthy subjects. Our second aim was to investigate whether being a night owl for migraine patients had a negative effect on their migraine-related disabilities or not.\u003c/p\u003e"},{"header":"Method","content":"\u003cp\u003eThis cross-sectional, prospective study included a total of 200 migraine patients who were recruited at the outpatient clinics of Neurology Departments of two hospitals between January 2019 and December 2019. Neurologists established the diagnosis of migraine according to the International Classification of Headache Disorders, third edition (ICHD-III) [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe inclusion criteria for this study were patients between 18\u0026ndash;60 years of age with a history of migraine for at least six months and were willing to participate in the study. Patients who presented with a headache of secondary nature, any unstable medical or psychiatric condition, a pregnancy, breastfeeding or night shift workers were excluded. As this study was mainly based on self-assessed questionnaires, illiterate patients were not included.\u003c/p\u003e\u003cp\u003eThe control group was composed of relatives of patients who underwent a workup at our neurophysiology units for various peripheral disorders. Volunteers were evaluated by neurologist and a diagnosis of migraine or frequent tension-type headache was excluded. They were also excluded according to the exclusion criteria of the study.\u003c/p\u003e\u003cp\u003eTwo hundred sixty-four patients with migraine and one hundred fifty-four volunteers were invited to study. Two hundred patients who suffered from migraine and 134 healthy subjects agree to participate in this study. Written informed consent was obtained from each subject following a detailed explanation of the study, and all participants were given an informed consent form. The objectives and protocol of the study, which was conducted by the ethical principles stated in the \"Declaration of Helsinki,\" was approved by the Acibadem University Clinical Research Ethics Committee.\u003c/p\u003e\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eStudy Measures\u003c/h2\u003e\u003cdiv id=\"Sec4\" class=\"Section3\"\u003e\u003ch2\u003eSociodemographic data form\u003c/h2\u003e\u003cp\u003eIn order to evaluate the sociodemographic characteristics of participants, both migraine patients and healthy subjects were asked to fill out a questionnaire that yielded information on age, sex, educational background, and occupation.\u003c/p\u003e\u003cp\u003eMigraine patients were questioned by neurologist about the duration and clinical characteristics of their migraines as well as, family history, presence of comorbidities, precipitating factors, medication overuse, previous use of prophylactic treatment, and current treatments. Migraine Disability Assessment Scale (MIDAS) was recorded by neurologists.\u003c/p\u003e\u003cp\u003eAll subjects completed Pittsburgh Sleep Quality Index (PSQI) and Morningness-Eveningness Questionnaire (MEQ) to evaluate sleep quality and chronotype assessment of the participants, respectively.\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\n\u003ch3\u003ePSQI\u003c/h3\u003e\n\u003cp\u003eThe Pittsburgh Sleep Quality Index (PSQI) is a questionnaire used to evaluate sleep quality during a previous month. It was developed by Buysse et al. [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. The Turkish reliability and validation was done by Agargun et al.[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. The PSQI questionnaire consists of nineteen self-rated questions, and if available, five questions are rated by the bed partner or roommate. Only self-rated questions are scored and combined to produce seven subcomponent scores; subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbances, use of sleeping medication, and daytime dysfunction. These subcomponents yield one global score that ranges from 0 to 21. A score\u0026thinsp;\u0026gt;\u0026thinsp;5 is indicated as a poor sleep. Higher scores are related to worse sleep quality.\u003c/p\u003e\n\u003ch3\u003eChronotype assessment: MEQ\u003c/h3\u003e\n\u003cp\u003eThe MEQ was used to define for the chronotype of people and determine whether their internal clock are more inclined to make them a night person such as a \"night owl\" or a morning person, a so-called \"early bird\". The questionnaire was first developed by Horne and Ostberg [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e], and the Turkish reliability and validation study was conducted by Punduk et al. [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. It contains 19 questions on sleep habits and fatigue. It categorizes patients into five groups, with the lowest scores associated with eveningness and higher scores with morningness. The scores vary between 16\u0026ndash;86. The total score was graded in turn; 16\u0026ndash;30 (Definite Evening), 31\u0026ndash;41 (Moderate Evening), 42\u0026ndash;58 (Intermediate), 59\u0026ndash;69 (Moderate Morning) and 70\u0026ndash;86 (Definite Morning).\u003c/p\u003e\n\u003ch3\u003eMIDAS\u003c/h3\u003e\n\u003cp\u003eMIDAS is a questionnaire developed by Stewart et al. [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e] and is composed of 5 questions that determine quantitatively the disability caused by migraine. MIDAS score calculates the sum of missed work or school days, missed household chores days, missed activity days outside the workplace as well as days at work or school plus days of household chores where productivity was reduced by 50% or more in the past three months due to migraine. The Turkish reliability and validation study was done by Ertas et al. [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. The total score was graded as follows: grade I (0 to 5 days) little or no disability; grade II (6 to 10 days), mild disability; grade III (11 to 20 days), moderate disability; and grade IV (higher than 21 days), severe disability.\u003c/p\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eStatistics\u003c/h2\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eA total 200 patients with migraine and 110 healthy volunteers were recruited in the study. Rates of episodic migraine (EM) and chronic migraine in (CM) our study were 53.5% (n\u0026thinsp;=\u0026thinsp;107) and 46.5% (n\u0026thinsp;=\u0026thinsp;93), respectively. Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e shows demographic features of all participants. Age and job status of two groups were not statistically different; however, female gender (81%) in the migraine group (MG) was higher than the control group (CG) (63.6%).\u003c/p\u003e\n\u003cp\u003eMIDAS scores of MG based on their chronotypes did not show any statistical difference (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e6\u003c/span\u003e); however the MIDAS scores were different between intermediate and morning chronotypes of MG (p\u0026thinsp;=\u0026thinsp;0.014) and the MIDAS-A scores were different between evening and morning chronotypes of MG (p\u0026thinsp;=\u0026thinsp;0.025).\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n \u003cdiv class=\"colspec\" align=\"left\"\u003e\u003cbr\u003e\u003c/div\u003e\n \u003ctable id=\"Tab1\" border=\"1\"\u003e\n \u003ccaption\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 1.\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\u0026nbsp;\u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eAll patient\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eChronic\u003c/p\u003e\n \u003c/th\u003e\n \u003cth colspan=\"2\" align=\"left\"\u003e\n \u003cp\u003eEpisodic\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eControl\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eP value\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePatient Number\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e200\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e107\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" align=\"left\"\u003e\n \u003cp\u003e110\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFemale (Gender) \u003cem\u003eN\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e162 (81%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e76 (81.72%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e86 (80.37%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" align=\"left\"\u003e\n \u003cp\u003e70 (63.64%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.001*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAge (Mean)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e34.49\u0026thinsp;\u0026plusmn;\u0026thinsp;7.92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e34.10\u0026thinsp;\u0026plusmn;\u0026thinsp;7.56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e34.84\u0026thinsp;\u0026plusmn;\u0026thinsp;8.25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" align=\"left\"\u003e\n \u003cp\u003e34.68\u0026thinsp;\u0026plusmn;\u0026thinsp;10.63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.478\u0026dagger;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" align=\"left\"\u003e\n \u003cp\u003eJob Status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd colspan=\"2\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.297*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEmployee (\u003cem\u003eN)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e164\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" align=\"left\"\u003e\n \u003cp\u003e91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHousewife\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" align=\"left\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eStudent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" align=\"left\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRetire\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" align=\"left\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u0026dagger; Wilcoxon Rank test between migraine and control. (Wilcox test for age between episodic and chronic migraine patient had p value as 0.373)\u003c/p\u003e\n\u003cp\u003e* Chi square test between migraine and control. (Distribution of gender among all migraine patients and control, this p\u0026thinsp;\u0026lt;\u0026thinsp;0.05 indicate that gender and having migraine was not independent. Distribution of gender among episodic and chronic migraine patients had p value as 0.951. Distribution all job status among all migraine and controls, this p\u0026thinsp;\u0026gt;\u0026thinsp;0.05 indicates that job status and having migraine were independent.)\u003c/p\u003e\n\u003cp\u003eTable\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u0026nbsp;demonstrates migraine features and MIDAS scores of all migraine patients as well as subgroups of EM and CM. In this study, 56.5% of the migraine patients had family history of migraine and there was no statistical differences between EM and CM patients. Medication overuse headache (MOH) was reported by 33% of migraine patients. Indeed, MOH was significantly higher in the CM patients (58%) compared to episodic ones (11.2%) (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Mean migraine duration of all patients was 10.70(\u0026plusmn;\u0026thinsp;8.01) months and there was no statistical differences between two migraine subgroups (p\u0026thinsp;=\u0026thinsp;0.303). Mean MIDAS scores of all patients were 21.97 (\u0026plusmn;\u0026thinsp;20.75) and it showed higher disability because of migraine. The MIDAS scores of CM and EM patients were 36.17 (\u0026plusmn;\u0026thinsp;21.09) and 9.63(\u0026plusmn;\u0026thinsp;9.58), respectively and the scores of two groups showed statistical significance (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Headache days for last three months were also highly different between EM and CM subgroups (13.80 vs. 52.89; (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Though the pain intensity for past three months which was reported by participants with EM and CM did not show statistical difference (7.7 vs. 6.96; p\u0026thinsp;=\u0026thinsp;0.344).\u003c/span\u003e\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n \u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n \u003ctable id=\"Tab2\" style=\"width: 552px;\" border=\"1\"\u003e\n \u003ccaption\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 2.\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\u0026nbsp;\u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth style=\"width: 176px;\" align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth style=\"width: 127px;\" align=\"left\"\u003e\n \u003cp\u003eAll Migraine Patients\u003c/p\u003e\n \u003c/th\u003e\n \u003cth style=\"width: 77px;\" align=\"left\"\u003e\n \u003cp\u003eChronic\u003c/p\u003e\n \u003c/th\u003e\n \u003cth style=\"width: 160.738px;\" colspan=\"2\" align=\"left\"\u003e\n \u003cp\u003eEpisodic\u003c/p\u003e\n \u003c/th\u003e\n \u003cth style=\"width: 64px;\" align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003ep-value\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 176px;\" align=\"left\"\u003e\n \u003cp\u003ePatient Number\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\" align=\"left\"\u003e\n \u003cp\u003e200\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\" align=\"left\"\u003e\n \u003cp\u003e93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 160.738px;\" colspan=\"2\" align=\"left\"\u003e\n \u003cp\u003e107\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 176px;\" align=\"left\"\u003e\n \u003cp\u003eMigraine in Family History (1) \u003cem\u003eN\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\" align=\"left\"\u003e\n \u003cp\u003e113\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\" align=\"left\"\u003e\n \u003cp\u003e51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 224.738px;\" colspan=\"3\" align=\"left\"\u003e\n \u003cp\u003e62 0.765*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 176px;\" align=\"left\"\u003e\n \u003cp\u003eMOH (1) \u003cem\u003eN\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\" align=\"left\"\u003e\n \u003cp\u003e66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\" align=\"left\"\u003e\n \u003cp\u003e54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77.3982px;\" align=\"left\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 147.34px;\" colspan=\"2\" align=\"left\"\u003e\n \u003cp\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.001*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 176px;\" align=\"left\"\u003e\n \u003cp\u003eMigraine Duration (Mean)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\" align=\"left\"\u003e\n \u003cp\u003e10.70\u0026thinsp;\u0026plusmn;\u0026thinsp;8.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\" align=\"left\"\u003e\n \u003cp\u003e11.27\u0026thinsp;\u0026plusmn;\u0026thinsp;8.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 224.738px;\" colspan=\"3\" align=\"left\"\u003e\n \u003cp\u003e10.21\u0026thinsp;\u0026plusmn;\u0026thinsp;7.90 0.303**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 176px;\" align=\"left\"\u003e\n \u003cp\u003eMIDAS score (Mean)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\" align=\"left\"\u003e\n \u003cp\u003e21.97\u0026thinsp;\u0026plusmn;\u0026thinsp;20.75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\" align=\"left\"\u003e\n \u003cp\u003e36.17\u0026thinsp;\u0026plusmn;\u0026thinsp;21.09\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77.3982px;\" align=\"left\"\u003e\n \u003cp\u003e9.63\u0026thinsp;\u0026plusmn;\u0026thinsp;9.58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 147.34px;\" colspan=\"2\" align=\"left\"\u003e\n \u003cp\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.001**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 176px;\" align=\"left\"\u003e\n \u003cp\u003eMIDAS A (Mean)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\" align=\"left\"\u003e\n \u003cp\u003e31.98\u0026thinsp;\u0026plusmn;\u0026thinsp;27.37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\" align=\"left\"\u003e\n \u003cp\u003e52.89\u0026thinsp;\u0026plusmn;\u0026thinsp;25.65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77.3982px;\" align=\"left\"\u003e\n \u003cp\u003e13.80\u0026thinsp;\u0026plusmn;\u0026thinsp;10.86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 147.34px;\" colspan=\"2\" align=\"left\"\u003e\n \u003cp\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.001**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 176px;\" align=\"left\"\u003e\n \u003cp\u003eMIDAS B (Mean)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\" align=\"left\"\u003e\n \u003cp\u003e7.32\u0026thinsp;\u0026plusmn;\u0026thinsp;3.62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\" align=\"left\"\u003e\n \u003cp\u003e7.73\u0026thinsp;\u0026plusmn;\u0026thinsp;5.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77.3982px;\" align=\"left\"\u003e\n \u003cp\u003e6.96\u0026thinsp;\u0026plusmn;\u0026thinsp;1.54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 147.34px;\" colspan=\"2\" align=\"left\"\u003e\n \u003cp\u003e0.344**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e*Chi square test between chronic and episodic migraine patients. (In this study migraine family history was not dependent to having chronic or episodic migraine. Distribution of IKKB and migraine type was dependent and distribution of IKKB different among episodic and chronic migraine patients.)\u003c/p\u003e\n\u003cp\u003e**Wilcoxon Rank test between scores of chronic and episodic migraine patients\u003c/p\u003e\n\u003cp\u003eTable\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e3\u0026nbsp;summarizes comparison of total PSQI scores and its subdivisions between the MG and the CG as well as two migraine subgroups. The sleep quality of CG was not poor (4.37). However, total scores of the patients showed poor sleep quality (7.28). The PSQI scores of CM and EM groups were 8.24 and 6.45, respectively (p\u0026thinsp;=\u0026thinsp;0.008). Comparison of the PSQI scores in the both CM (8.24) and EM (6.45) showed statistical significant difference with the CG (4.37) (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The subdivisions of PSQI scores (subjective sleep quality, sleep latency, sleep duration, habitual sleep deficiency, sleep disturbances, sleep medicine usage, daytime dysfunction) showed statistical differences between the MG and the CG. Episodic migraine and CM patients also had differences between sleep disturbances subdivision. Comparison of patients with CM and CG showed higher number of differences for all PSQI subdivisions between two groups. The sleep latency, sleep duration and usage of sleeping medicine subdivisions of the PSQI between patients with EM and CG did not show any statistical difference. Habitual sleep deficiency, sleep disturbances and usage of sleeping medicine subdivisions showed statistical difference between CM and EM groups.\u003c/span\u003e\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n \u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n \u003ctable id=\"Tab3\" border=\"1\"\u003e\n \u003ccaption\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 3.\u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePSQI\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eAll patients\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eChronic\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eEpisodic\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eControl\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePSQI total score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7.28\u0026thinsp;\u0026plusmn;\u0026thinsp;4.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8.24\u0026thinsp;\u0026plusmn;\u0026thinsp;4.45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6.45\u0026thinsp;\u0026plusmn;\u0026thinsp;3.74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.37\u0026thinsp;\u0026plusmn;\u0026thinsp;1.73\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSubjective Sleep Quality (C1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.35\u0026thinsp;\u0026plusmn;\u0026thinsp;0.71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.45\u0026thinsp;\u0026plusmn;\u0026thinsp;0.71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.26\u0026thinsp;\u0026plusmn;\u0026thinsp;0.70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.94\u0026thinsp;\u0026plusmn;\u0026thinsp;0.47\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSleep latency (C2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.27\u0026thinsp;\u0026plusmn;\u0026thinsp;0.96\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.37\u0026thinsp;\u0026plusmn;\u0026thinsp;0.94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.19\u0026thinsp;\u0026plusmn;\u0026thinsp;0.97\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.86\u0026thinsp;\u0026plusmn;\u0026thinsp;0.80\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSleep Duration (C3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.92\u0026thinsp;\u0026plusmn;\u0026thinsp;0.99\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.05\u0026thinsp;\u0026plusmn;\u0026thinsp;1.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.81\u0026thinsp;\u0026plusmn;\u0026thinsp;0.96\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.49\u0026thinsp;\u0026plusmn;\u0026thinsp;0.71\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHabitual Sleep Deficiency (C4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.72\u0026thinsp;\u0026plusmn;\u0026thinsp;1.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.87\u0026thinsp;\u0026plusmn;\u0026thinsp;1.09\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.60\u0026thinsp;\u0026plusmn;\u0026thinsp;0.94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.19\u0026thinsp;\u0026plusmn;\u0026thinsp;0.48\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSleep Disturbances (C5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.48\u0026thinsp;\u0026plusmn;\u0026thinsp;0.74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.69\u0026thinsp;\u0026plusmn;\u0026thinsp;0.77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.29\u0026thinsp;\u0026plusmn;\u0026thinsp;0.66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.08\u0026thinsp;\u0026plusmn;\u0026thinsp;0.45\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUse Sleeping Med (C6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.31\u0026thinsp;\u0026plusmn;\u0026thinsp;0.82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.47\u0026thinsp;\u0026plusmn;\u0026thinsp;1.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.17\u0026thinsp;\u0026plusmn;\u0026thinsp;0.56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.05\u0026thinsp;\u0026plusmn;\u0026thinsp;0.27\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDaytime dysfunction (C7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.23\u0026thinsp;\u0026plusmn;\u0026thinsp;0.93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.33\u0026thinsp;\u0026plusmn;\u0026thinsp;0.97\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.13\u0026thinsp;\u0026plusmn;\u0026thinsp;0.89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.76\u0026thinsp;\u0026plusmn;\u0026thinsp;0.69\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eTable\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e4\u0026nbsp;shows chronotypes of MG and CG based on the MEQ scores and there was no statistical differences between two groups (p\u0026thinsp;=\u0026thinsp;0.48). Intermediate sleep chronotypes was the most common one in both the migraine and control groups (61.5% vs 54.5%). These results was consistent with patients for the CM and the EM (p\u0026thinsp;=\u0026thinsp;0.140). Morning, intermediate and evening chronotypes in MG and CG were (n\u0026thinsp;=\u0026thinsp;55, 27.5% vs. n\u0026thinsp;=\u0026thinsp;35, 31.8%), (n\u0026thinsp;=\u0026thinsp;123, 61.5% vs. n\u0026thinsp;=\u0026thinsp;60, 54.5%) and (n\u0026thinsp;=\u0026thinsp;22, 11% vs. n\u0026thinsp;=\u0026thinsp;15, 13.7%), respectively (p\u0026thinsp;=\u0026thinsp;0.48). A distribution of three chronotypes in EM group was morning (n\u0026thinsp;=\u0026thinsp;35, 32.7%), intermediate (n\u0026thinsp;=\u0026thinsp;63, 58.9%) and evening (n\u0026thinsp;=\u0026thinsp;9, 8.4%). A distribution of three phenotypes in CM group was morning (n\u0026thinsp;=\u0026thinsp;20, 21.5%), intermediate (n\u0026thinsp;=\u0026thinsp;60, 64.5%) and evening (n\u0026thinsp;=\u0026thinsp;13, 14%). Rates of three chronotypes in EM and CM groups did not statistically different (p\u0026thinsp;=\u0026thinsp;0.140).\u003c/span\u003e\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n \u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n \u003ctable id=\"Tab4\" border=\"1\"\u003e\n \u003ccaption\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 4.\u0026nbsp;\u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eEvening\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eIntermediate\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eMorning\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMigraine \u003cem\u003eN(%)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e22 (11%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e123 (61.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e55 (27.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eControl \u003cem\u003eN(%)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15 (13.67%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e60 (54.55%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e35 (31.82%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eP value*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" align=\"left\"\u003e\n \u003cp\u003e0.484*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e*Chi square test for distribution of sleeping types between migraine and control groups.\u003c/p\u003e\n\u003cp\u003eTable\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e5\u0026nbsp;demonstrates the total PSQI scores and the subdivisions of PSQI in three chronotypes of the MG. Post hoc analysis which was done for if only significant p values available among three chronotypes of MG patients. Total PSQI scores and subjective sleep quality, sleep latency, sleep disturbances and daytime dysfunction subdivisions showed statistically better results in morning chronotype group.\u003c/span\u003e\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n \u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n \u003ctable id=\"Tab5\" border=\"1\"\u003e\n \u003ccaption\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 5.\u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eSleep Parameter\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eEvening\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eIntermediate\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eMorning\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eP value*\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSubjective Sleep Quality (C1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.45\u0026thinsp;\u0026plusmn;\u0026thinsp;0.59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.43\u0026thinsp;\u0026plusmn;\u0026thinsp;0.71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.13\u0026thinsp;\u0026plusmn;\u0026thinsp;0.72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.026*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSleep latency (C2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.32\u0026thinsp;\u0026plusmn;\u0026thinsp;0.99\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.45\u0026thinsp;\u0026plusmn;\u0026thinsp;0.95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.85\u0026thinsp;\u0026plusmn;\u0026thinsp;0.85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSleep Duration (C3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.95\u0026thinsp;\u0026plusmn;\u0026thinsp;1.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.97\u0026thinsp;\u0026plusmn;\u0026thinsp;0.99\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.82\u0026thinsp;\u0026plusmn;\u0026thinsp;0.98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.558\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHabitual Sleep Deficiency (C4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.54\u0026thinsp;\u0026plusmn;\u0026thinsp;1.10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.79\u0026thinsp;\u0026plusmn;\u0026thinsp;1.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.65\u0026thinsp;\u0026plusmn;\u0026thinsp;0.97\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.232\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSleep Disturbances (C5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.50\u0026thinsp;\u0026plusmn;\u0026thinsp;0.86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.56\u0026thinsp;\u0026plusmn;\u0026thinsp;0.70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.28\u0026thinsp;\u0026plusmn;\u0026thinsp;0.73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.044*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUse Sleeping Med (C6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.37\u0026thinsp;\u0026plusmn;\u0026thinsp;0.79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.38\u0026thinsp;\u0026plusmn;\u0026thinsp;0.91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.12\u0026thinsp;\u0026plusmn;\u0026thinsp;0.58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.066\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDaytime dysfunction (C7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.55\u0026thinsp;\u0026plusmn;\u0026thinsp;0.91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.35\u0026thinsp;\u0026plusmn;\u0026thinsp;0.94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.82\u0026thinsp;\u0026plusmn;\u0026thinsp;0.79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePSQI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7.68\u0026thinsp;\u0026plusmn;\u0026thinsp;3.98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7.93\u0026thinsp;\u0026plusmn;\u0026thinsp;4.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5.67\u0026thinsp;\u0026plusmn;\u0026thinsp;3.95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.002**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cdiv class=\"gridtable\"\u003e\n \u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n \u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n \u003ctable id=\"Tab6\" border=\"1\"\u003e\n \u003ccaption\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 6.\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\u0026nbsp;\u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eEvening\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eIntermediate\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eMorning\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eActivity Score\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eChronic \u003cem\u003eN(%)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13 (13.98%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e60 (64.52%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20 (21.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e50.85\u0026thinsp;\u0026plusmn;\u0026thinsp;9.02\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEpisodic \u003cem\u003eN(%)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9 (8.41%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e63 (58.88%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e35 (32.71%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e53.80\u0026thinsp;\u0026plusmn;\u0026thinsp;9.25\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eP value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd colspan=\"2\" align=\"left\"\u003e\n \u003cp\u003e0.140 *\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.023**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e*Chi square test between episodic and chronic migraine groups.\u003c/p\u003e\n\u003cp\u003e**Welch Two Sample t-test between chronic and episodic patients\u0026rsquo; activity scores.\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n \u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n \u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n \u003ctable id=\"Tab7\" border=\"1\"\u003e\n \u003ccaption\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 7.\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\u0026nbsp;\u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eEvening\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eIntermediate\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eMorning\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eP value*\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMIDAS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e23.55\u0026thinsp;\u0026plusmn;\u0026thinsp;20.85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e23.93\u0026thinsp;\u0026plusmn;\u0026thinsp;22.28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e16.95\u0026thinsp;\u0026plusmn;\u0026thinsp;16.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.082\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMIDAS A\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e42.73\u0026thinsp;\u0026plusmn;\u0026thinsp;31.39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e31.74\u0026thinsp;\u0026plusmn;\u0026thinsp;25.95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e28.22\u0026thinsp;\u0026plusmn;\u0026thinsp;28.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.133\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMIDAS B\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6.95\u0026thinsp;\u0026plusmn;\u0026thinsp;1.13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7.07\u0026thinsp;\u0026plusmn;\u0026thinsp;1.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8.04\u0026thinsp;\u0026plusmn;\u0026thinsp;6.48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.681\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn our study, both the migraine group (MG) showed poor sleep quality, with PSQI scores significantly higher in migraine patients. Although episodic migraine (EM) participants and the control group (CG) showed no difference in sleep quality, chronic migraine (CM) patients had the highest PSQI scores and experienced more daytime dysfunction than the CG. This finding suggests that migraine chronicity is associated with increasingly poor sleep quality. Among chronotypes, the intermediate type was the most common in both MG and CG. When comparing total PSQI scores and sub-scores among chronotypes in the MG, morning types demonstrated better sleep quality, shorter sleep latency, and better daytime function than the intermediate and evening types. MIDAS scores were lowest among morning chronotypes. However, no statistically significant difference in migraine-related disability was found among the three chronotypes.\u003c/p\u003e\u003cp\u003eAs expected, CM patients had higher migraine-related disability and more frequent medication overuse headache (MOH) than EM patients. CM patients also experienced the most severe impact on sleep quality. Our findings align with those of Gori et al.[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e], who found that sleep latency was the most affected sleep aspect in migraine patients. However, our results show that all PSQI sub-scores were worse in MG compared to CG, with CM patients experiencing the most severe sleep issues, including increased habitual sleep deficiency, sleep disturbances, and sleep medication use.\u003c/p\u003e\u003cp\u003eComparison of sleep issues in EM and CM patients indicated that habitual sleep deficiency, sleep disturbances, and medication use were most common in CM patients. Sleep disturbances and medication use, in particular, were the most frequently affected aspects of sleep among all migraine patients, likely contributing to daytime dysfunction in the CM group.\u003c/p\u003e\u003cp\u003eIn contrast to the findings by Van Oosterhout et al.[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e], who reported that early and late chronotypes were more prevalent among migraine patients than in non-headache controls, our results did not show a significant difference in chronotype distribution between MG and CG, with the intermediate type being the most common in both groups. While Van Oosterhout used the Munich Chronotype Questionnaire, we used the Morningness-Eveningness Questionnaire (MEQ), which might account for some of these differences. Cevoli et al., using the MEQ as well, found similar results to ours, with the intermediate type being the most common in migraine patients [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Thus, while there are some variations across studies, the distribution of chronotypes in migraine patients remains an area for further exploration.\u003c/p\u003e\u003cp\u003eOur study showed no statistically significant difference in migraine-related disability across the three chronotypes within the MG, although MIDAS scores indicated moderate disability in morning chronotypes and severe disability in intermediate and evening chronotypes. While the difference in MIDAS scores between intermediate and morning chronotypes was statistically significant, differences among other chronotypes were not. Gori et al. reported that morning and evening types had poorer sleep and higher migraine-related disability compared to intermediate types [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e], which was partly consistent with our findings. The findings of Viticchi et al. similarly support the idea that chronotype may influence the frequency and duration of migraine attacks [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eOur study has some limitations. First, the MG was predominantly composed of females compared to the CG, which may have influenced our findings.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgments\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe author has no acknowledgments to declare.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eErkan Acar: Conceptualization, Methodology, Formal analysis, Writing \u0026ndash; Original Draft, Supervision, Project administration, Correspondence.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eZeynep \u0026Ouml;zdemir: Data curation, Investigation, Patient recruitment, Writing \u0026ndash; Review \u0026amp; Editing.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003ePınar Yalınay Dikmen: Methodology, Validation, Writing \u0026ndash; Review \u0026amp; Editing, Supervision.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThere was no funding.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of Data and Materials\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets produced and/or examined during the present investigation are not accessible to the public but can be obtained from the corresponding author upon a reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was conducted in accordance with the declaration of Helsinki and was approved by the ethics committee of Acibadem Mehmet Ali Aydinlar University approved the study with a reference number of 2019-01/19. Written informed consent was acquired from all the participants at the time of participation.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare there is no competing interests.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eGillette MU, Mitchell JW. Signaling in the suprachiasmatic nucleus: Selectively responsive and integrative. Cell Tissue Res. 2002;309:99\u0026ndash;107.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003evan Esseveldt LE, Lehman MN, Boer GJ. The suprachiasmatic nucleus and the circadian time-keeping system revisited. Brain Res Rev. 2000;33:34\u0026ndash;77.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKleitman N, STUDIES ON THE PHYSIOLOGY, OF SLEEP. https://doi.org/101152/ajplegacy19331042449. 1933;104:449\u0026ndash;56.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eStovner LJ, Nichols E, Steiner TJ, Abd-Allah F, Abdelalim A, Al-Raddadi RM, et al. Global, regional, and national burden of migraine and tension-type headache, 1990\u0026ndash;2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Neurol. 2018;17:954\u0026ndash;76.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGori S, Morelli N, Maestri M, Fabbrini M, Bonanni E, Murri L. Sleep quality, chronotypes and preferential timing of attacks in migraine without aura. J Headache Pain. 2005;6:258\u0026ndash;60.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCevoli S, Nicodemo M, Grimaldi D, Leonardi L, Montagna P, Cortelli P et al. Chronotypes in menstrual migraine: A case-control study. Neurol Sci. 2010;31 SUPPL.1.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eViticchi G, Falsetti L, Paolucci M, Altamura C, Buratti L, Salvemini S, et al. Influence of chronotype on migraine characteristics. Neurol Sci. 2019;40:1841\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWaliszewska-Pros\u0026oacute;ł M, Nowakowska-Kotas M, Chojdak-łukasiewicz J, Budrewicz S. Migraine and Sleep\u0026mdash;An Unexplained Association? Int J Mol Sci. 2021;22:5539.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKelman L, Rains JC. Headache and sleep: Examination of sleep patterns and complaints in a large clinical sample of migraineurs. Headache. 2005;45:904\u0026ndash;10.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSeidel S, Hartl T, Weber M, Matterey S, Paul A, Riederer F, et al. Quality of sleep, fatigue and daytime sleepiness in migraine - A controlled study. Cephalalgia. 2009;29:662\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSleep quality and depression among patients with migraine - PubMed. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://pubmed.ncbi.nlm.nih.gov/24390948/\u003c/span\u003e\u003cspan address=\"https://pubmed.ncbi.nlm.nih.gov/24390948/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Accessed 3 Jun 2025.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eYalinay Dikmen P, Yavuz BG, Aydinlar EI. The relationships between migraine, depression, anxiety, stress, and sleep disturbances. Acta Neurol Belg. 2015;115:117\u0026ndash;22.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eThe International Classification of Headache Disorders, 3rd edition, Copyright. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1177/0333102417738202\u003c/span\u003e\u003cspan address=\"10.1177/0333102417738202\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBuysse DJ, Reynolds CF, Monk TH, Berman SR, Kupfer DJ. The Pittsburgh sleep quality index: A new instrument for psychiatric practice and research. Psychiatry Res. 1989;28:193\u0026ndash;213.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAğarg\u0026uuml;n M, Kara H, Anlar O. The Validity and reliability of the Pittsburgh Sleep Quality Index. 1996.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHorne JA, \u0026Ouml;stberg O, Morningness-Eveningness Q. PsycTESTS Dataset. 2016. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1037/T02254-000\u003c/span\u003e\u003cspan address=\"10.1037/T02254-000\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eP\u0026uuml;nd\u0026uuml;k Z, G\u0026uuml;r H, Ercan İ. A Reliability Study of The Turkish Version of The Morningness-Eveningness Questionnaire T\u0026uuml;rk Psikiyatri Dergisi. 2005; 16(1): Turkish Journal of Psychiatry.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eStewart WF, Lipton RB, Dowson AJ, Sawyer J. Development and testing of the Migraine Disability Assessment (MIDAS) Questionnaire to assess headache-related disability. Neurology. 2001;56 6 SUPPL. 1.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eErtaş M, Siva A, Dalkara T, Uzuner N, Dora B, Inan L, et al. Validity and reliability of the Turkish Migraine Disability Assessment (MIDAS) questionnaire. Headache. 2004;44:786\u0026ndash;93.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003evan Oosterhout WPJ, van Someren EJW, Schoonman GG, Louter MA, Lammers GJ, Ferrari MD, et al. Chronotypes and circadian timing in migraine. Cephalalgia. 2018;38:617\u0026ndash;25.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"migraine, circadian, migraine-related disability, morningness, eveningness","lastPublishedDoi":"10.21203/rs.3.rs-6768112/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6768112/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e Emerging evidence suggests circadian rhythms may influence migraine pathophysiology. This study investigates the association between chronotype and migraine-related disability.\u003cbr\u003e\n \u003cstrong\u003eMethods:\u003c/strong\u003e In this cross-sectional study, 200 migraine patients and 134 controls completed the Pittsburgh Sleep Quality Index (PSQI), Morningness-Eveningness Questionnaire (MEQ), and Migraine Disability Assessment Scale (MIDAS).\u003cbr\u003e\n \u003cstrong\u003eResults:\u003c/strong\u003e Migraine patients exhibited poorer sleep quality (PSQI: 7.28 vs. 4.37, p\u0026lt;0.001), with chronic migraine (CM) patients showing the highest disability (MIDAS: 36.17 vs. 9.63, p\u0026lt;0.001). No significant difference in chronotype distribution was observed between groups (p=0.48). Morning chronotypes had lower MIDAS scores (16.95±16.17) compared to intermediate (23.93±22.28) and evening types (23.55±20.85), though differences were non-significant (p=0.082).\u003cbr\u003e\n \u003cstrong\u003eConclusions:\u003c/strong\u003e While chronotype does not directly correlate with migraine-related disability, poor sleep quality in migraine patients, particularly those with CM, underscores the need for sleep-focused interventions.\u003c/p\u003e","manuscriptTitle":"Does being a night owl in migraine have any connection to higher migraine-related disability?","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-07-18 14:14:14","doi":"10.21203/rs.3.rs-6768112/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"364e153d-1bd4-4fc0-b672-cf9fe4e59ce9","owner":[],"postedDate":"July 18th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-03-04T10:57:09+00:00","versionOfRecord":[],"versionCreatedAt":"2025-07-18 14:14:14","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6768112","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6768112","identity":"rs-6768112","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}