Evening Chronotype Associates With Worse Physical and Mental Health and Headache-Related Disability Among Migraine Patients.

Migraine has been linked to chronotype, but with mixed results. Here, we tested chronotype in association with physical and mental health and headache characteristics in a large database of migraine patients and controls. A sample of the UK Biobank (n = 360,081; 58.3% female, mean age: 56.38) was used. Data included self-reported chronotype, mental (neuroticism, depression, stress) and physical (body fat percentage, overall health rating) health factors, and migraine diagnosis based on ICD-10 G43 diagnosis from healthcare data. Morning type controls (C_morning, n = 210,775), evening type controls (C_evening, n = 129,174), morning type migraine patients (M_morning, n = 12,194), and evening type migraine patients (M_evening, n = 7938) were compared. Additionally, in a subsample of questionnaire-based migraine (n = 15,356), chronotype was tested in association with headache-related features. One-way ANOVA, Kruskal-Wallis test and chi-squared test were run in SPSS 28 with Bonferroni correction. Evening chronotype was more frequent among migraine patients with an OR = 1.06, 95% CI [1.03; 1.09] compared to controls (χ² = 16.523, p < 0.001). The M_evening group showed the worst level of all mental and physical health variables, while the C_morning group reported the best values. Migraine patients with morning or evening chronotype showed a highly similar headache symptom profile, but the M_evening subgroup expressed a higher disability (t = -3.965, p < 0.001). In conclusion, evening chronotype was associated with the worst physical and mental health status and the highest headache-related disability among migraine patients, suggesting a need for elevated medical attention on chronotype in migraine.