Migraine – a weekend phenomenon?

The most strenuous events are not usually distributed evenly across the week. Monday mornings (that notorious 8. a.m. lecture...) can frazzle your nerves and set the week off to a highly stressful start. And a seminar scheduled for a Friday afternoon may leave you completely drained because your brain is mush after a hard week. Even when that’s thankfully over and done with, many students face a tough weekend trip home to friends and family, or the demands of their part-time job. We’re all familiar with those periods of intense stress in our lives, be it at uni, at work, and elsewhere. Even without a cluster of stressful events, “ordinary” pressures combined with the demands you make on yourself may leave you struggling with a stubborn headache or migraine attack just when you were about to go out and have fun, meet friends, or just relax and de-compress: at the weekend. With so many anecdotal reports of the weekend migraine phenomenon, what’s going on? Is it real or a misconception?

What does the science have to say? Let’s have a look at some of the research.

Hard research evidence

Scientists first attempted to get to the bottom of the phenomenon 30 years ago. But not much was known about migraine at the time – nowhere near as much as now – and those first studies delivered contradictory and inconclusive results. Also, there was no awareness at the time that migraineurs can do a lot to prevent and mitigate attacks.

The renowned Karolinska Institute in Stockholm published a study on migraine attack patterns over the course of a week. Over a period of about two months, migraineurs recorded how often they got migraines and on which days of the week. The results showed no evidence of a higher incidence on weekends; rather, attacks were distributed fairly evenly throughout the week. In short, this study did not support the weekend hypothesis.

At about the same time, Pietro Cugini based at the University of La Sapienza, Rome published a 12-month study reporting an accumulation of migraine attacks both on weekends and in the winter months – but failed to come up with any insight into the causes of the phenomenon.

In a Norwegian study, female migraineurs logged full details of their migraine attacks over a year. Evaluation of the data showed an almost equal distribution over the days of the week. There were even signs of a decrease on Sundays and days off. Saturday did not differ in migraine frequency from the other days of the week. The authors attribute the consistency in headache onset across six out of seven days of the week to the fact that Saturday is not a designated day of rest for most people but full of activities and therefore not that different from ordinary workdays. So there was no evidence for weekend headache clustering in this study either. On the contrary, it even suggests that days off may help protect against migraine.

The influence of sleep and caffeine

UK scientists looked at another two factors that have been linked to migraine attacks since forever: caffeine and sleep habits. Statistics indicate that working people take significantly more caffeinated beverages during their work week than on weekends, with caffeine consumption starting early in the day. Weekend habits differ in several ways: people sleep more (about an hour longer), have their first coffee or tea later in the day, and consume less caffeine overall on the weekend. The authors suspect that these are factors that might promote or even trigger attacks in some migraineurs. The study did in fact produce results that would support this theory. Everyone who reported weekend migraines had particularly high levels of caffeine consumption on weekdays, and slept longer on weekends than the average across the study population. Respondents with no change in their caffeine and sleep were symptom-free. The main takeaway from this study: weekend migraine does not exist as an independent phenomenon, but altered consumption and sleep habits may well act as triggers.

A shared limitation of all these studies is a small patient population, which undermines the statistical power of the research and lowers the evidence level.

A recent study based on information collected from 1000 participants gives a more nuanced picture of headache onset and highlights some features. The total study population was large enough to identify subgroups of people with similar migraine patterns. Some subjects experienced a midweek migraine cluster. Another subgroup was mainly affected on weekends, Saturdays in particular. Overall, however, distribution was highly individual with no discernible universal regularity. The authors point out that lifestyles, work arrangements, eating and drinking habits and stress levels differed greatly between participants, making it hard to identify distinct patterns in terms of factors that can promote or trigger migraine attacks. Again, this extensive study does not pinpoint "peak times" where all migraine patients struggle equally. Bottom line: weekend migraine may be a thing many people experience on an individual level but scientific evidence for a clinical entity called weekend migraine is lacking at this point.

So what is a person supposed to do?

The message is not that you’re at the mercy of your migraine. The vast body of evidence on migraine causes, contributing factors and correlates gathered over the decades has helped develop an effective toolkit people can use to manage the frequency, duration and severity of migraine attacks. The recommendations compiled on our website are a great starting point. If you want to perfect your headache prevention game and pimp your lifestyle to beat migraine, our medically certified "Headache Hurts" app is the tool for you.