Counseling about “healthy habits” may not actually impact migraine frequency and thus becomes an empty promise that alienates teenagers. This is the unexpected conclusion of a study published in Headache in 2019, looking at high school start time and migraine frequency.

Teens have a delayed sleep phase, leading them to go to sleep later and awaken later than children and adults. Early high school start times can result in sleep deprivation. 18% of high schools in the US now have 8:30 AM start times.

Support for “healthy habits” comes from another study of migraineurs aged 8–17. All subjects were counseled at each clinic visit about migraine triggers, including the importance of sleep. They were also treated with topiramate, amitriptyline or placebo. The medication groups did not have fewer headaches than the placebo group and were more likely to have side effects. It seemed that lifestyle counseling was as effective as a preventative medication.

The new study came to a different conclusion. Researchers controlled for triggers such as missing breakfast. The group with a start time of 8:30 AM did not have fewer headaches. Emphasizing interventions that don’t work blames the patient for poor migraine control and damages the doctor-patient relationship.

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