The longitudinal association between shift work and headache: results from the Danish PRISME cohort

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We investigated the effect of shift work on headache. Furthermore, we investigated whether the association between shift work and headache was explained by potential mediators in terms of perceived stress, poor sleep and health behaviors.


In this longitudinal study, we used questionnaire data (collected in 2007 and 2009) from civil servants and hospital employees from the PRISME study. 2952 individuals were available for the analyses of shift work and headache and 2272 individuals were available for the analyses of shift work and migraine. Headache was operationalized as the participants’ experience of “being bothered by headache during the past 4 weeks”. Migraine was operationalized as “ever being diagnosed with migraine by a medical doctor”. We used binary logistic regression to compare shift workers with permanent day workers and adjusted for socio-demographic factors. In a subsequent step, we adjusted for potential mediators.


We found higher odds of unspecific headache (OR = 1.25; 95% CI 1.02–1.54) and migraine (OR = 1.72; 95% CI 1.04–2.86) among shift workers compared with day workers. Our results suggest that the effect of shift work on headache and migraine differ between men and women. Inclusion of potential mediators in the analyses did not attenuate the associations.


Shift workers have higher risk of reporting being bothered by headache as well as reporting being diagnosed with migraine. Future research is needed to disentangle the underlying mechanisms with the aim of reducing headache related to occupational exposures.

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  1. Aguggia M et al (2011) Sleep and primary headaches. Neurol Sci 32:S51–54

  2. Åkerstedt T (2003) Shift work and disturbed sleep/wakefulness. Occup Med 53:89–94

  3. Åkerstedt T, Knutsson A, Westerholm P, Theorell T, Alfredsson L, Kecklund G (2002) Sleep disturbances, work stress and work hours: a cross-sectional study. J Psychosom Res 53:741–748

  4. Alfredsson L, Åkerstedt T, Mattsson M, Wilborg B (1991) Self-reported health and well-being amongst night security guards: a comparison with the working population. Ergonomics 34:525–530

  5. Alstadhaug K, Salvesen R, Bekkelund S (2008) 24-hour distribution of migraine attacks. Headache 48:95–100.

  6. Bjorvatn B, Pallesen S, Moen BE, Waage S, Kristoffersen ES (2018) Migraine, tension-type headache and medication-overuse headache in a large population of shift working nurses: a cross-sectional study in Norway. BMJ Open 8:e022403

  7. Bøggild H, Knutsson A (1999) Shift work, risk factors and cardiovascular disease. Scand J Work Environ Health 25:85–99

  8. Cathcart S, Winefield AH, Lushington K, Rolan P (2010) Stress and tension-type headache mechanisms. Cephalalgia 30:1250–1267

  9. Chan OY, Gan SL, Yeo MH (1993) Study on the health of female electronics workers on 12 hour shifts. Occup Med 43:143–148

  10. Christensen KS, Fink P, Toft T, Frostholm L, Ørnbøl E, Olesen F (2005) A brief case-finding questionnaire for common mental disorders: the CMDQ. Fam Pract 22:448–457

  11. Cohen S, Kamarck T, Mermelstein R (1983) A global measure of perceived stress. J Health Soc Behav 24:385–396

  12. Frost P, Kolstad HA, Bonde JP (2009) Shift work and the risk of ischemic heart disease—a systematic review of the epidemiologic evidence. Scand J Work Environ Health 35:163–179

  13. Garde AH, Hansen J, Kolstad HA, Larsen AD, Pedersen J, Petersen JD, Hansen AM (2018) Payroll data based description of working hours in the Danish regions. Chronobiol Int 35:795–800

  14. Gelaye JB, Sacco LS, Brown LW, Nitchie LH, Ornello LR, Peterlin LB (2017) Body composition status and the risk of migraine: a meta-analysis. Neurology 88:1795–1804

  15. Gowrisankaran S, Sheedy JE (2015) Computer vision syndrome: a review. Work 52:303–314

  16. Hanson LL, Akerstedt T, Naswall K, Leineweber C, Theorell T, Westerlund H (2011) Cross-lagged relationships between workplace demands, control, support, and sleep problems. Sleep 34:1403–1410

  17. Ho KH, Benjamin KC (2001) Perceived headache associations in Singapore: results of a randomized national survey. Headache 41:164–170

  18. Jakobsen GS, Timm AM, Hansen AM, Garde AH, Nabe-Nielsen K (2017) The association between shift work and treatment-seeking migraine in Denmark. Ergonomics 60:1207–1217

  19. Jensen R, Rasmussen BK (2004) Burden of headache. Expert Rev Pharmacoecon Outcomes Res 4:353–359

  20. Kaerlev L et al (2011) Are risk estimates biased in follow-up studies of psychosocial factors with low base-line participation? BMC Public Health 11:539

  21. Kecklund G, Axelsson J (2016) Health consequences of shift work and insufficient sleep. BMJ 355:i5210

  22. Knutsson A (2004) Methodological Aspects of Shift-Work Research. Chronobiol Int 21:1037–1047

  23. Kopec JA, Sayre EC (2004) Work-related psychosocial factors and chronic pain: a prospective cohort study in Canadian workers. J Occup Environ Med 46:1263–1271

  24. Lash TL, Fox MP, Fink AK (2009) Applying quantitative bias analysis to epidemiologic data. Springer New York, New York

  25. Lee E-H (2012) Review of the psychometric evidence of the perceived stress scale. Asian Nurs Res 6:121–127

  26. Lyngberg AC, Rasmussen BK, Jorgensen T, Jensen R (2005) Incidence of primary headache: a Danish epidemiologic follow-up study. Am J Epidemiol 161:1066–1073

  27. Molarius A, Tegelberg A, Ohrvik J (2008) Socio-economic factors, lifestyle, and headache disorders—a population-based study in Sweden. Headache 48:1426–1437

  28. Parikh SK, Young WB (2019) Migraine: stigma in society. Curr Pain Headache Rep 23:8.

  29. Parkes KR (1999) Shiftwork, job type, and the work environment as joint predictors of health-related outcomes. J Occup Health Psychol 4:256–268

  30. Peroutka S (2014) What turns on a migraine? A systematic review of migraine precipitating factors. Curr Pain Headache Rep 18:1–6

  31. Portela LF, Rotenberg L, Waissmann W (2009) Self-reported health and sleep complaints among nursing personnel working under 12 h night and day shifts. Chronobiol Int 21:859–870

  32. Puttonen S, Härmä M, Hublin C (2010) Shift work and cardiovascular disease—pathways from circadian stress to morbidity. Scand J Work Environ Health 36:96–108

  33. Rains JC, Poceta JS (2012) Sleep-related headaches. Neurol Clin 30:1285

  34. Rod NH, Grønbæk M, Schnohr P, Prescott E, Kristensen TS (2009) Perceived stress as a risk factor for changes in health behaviour and cardiac risk profile: a longitudinal study. J Intern Med 266:467–475

  35. Sandoe CH, Sasikumar S, Lay C, Lawler V (2019) The impact of shift work on migraine: a case series and narrative review. Headache 59:1631–1640.

  36. Selekler MH, Gökmen G, Steiner TJ (2013) Productivity impact of headache on a heavy-manufacturing workforce in Turkey. J Headache Pain 14:88

  37. Steiner TJ et al (2014) Diagnosis, prevalence estimation and burden measurement in population surveys of headache: presenting the HARDSHIP questionnaire. J Headache Pain 15:3

  38. Straube A, Andreou A (2019) Primary headaches during lifespan. J Headache Pain 20:35.

  39. Sundhedsstyrelsen and Statens Institut for Folkesundhed (2017) Danskernes Sundhed: Tal fra Den Nationale Sundhedsprofil. Accessed 13 Mar 2018

  40. Suwazono Y et al (2008) A longitudinal study on the effect of shift work on weight gain in male Japanese workers. Obesity 16:1887–1893

  41. Taylor FR (2015) Tobacco, nicotine, and headache. Headache J Head Face Pain 55:1028–1044

  42. Tsai RJ, Luckhaupt SE, Sweeney MH, Calvert GM (2014) Shift work and cancer screening: do females who work alternative shifts undergo recommended cancer screening? Am J Ind Med 57:265–275

  43. Wang Y et al (2015) The prevalence of primary headache disorders and their associated factors among nursing staff in North China. J Headache Pain 16:4

  44. Westergaard ML, Glümer C, Hansen EH, Jensen RH (2014) Prevalence of chronic headache with and without medication overuse: associations with socioeconomic position and physical and mental health status. Pain 155:2005–2013

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Correspondence to Andreas Moses Appel.

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The authors declare that they have no conflict of interest.

Ethical approval

The data collection was approved by The Danish National Committee on Health Research Ethics (RRS 2006–1028, 2747-06) and the Danish Data Protection Agency (2009-41-3215). The study was in accordance with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Appel, A.M., Török, E., Jensen, M.A. et al. The longitudinal association between shift work and headache: results from the Danish PRISME cohort. Int Arch Occup Environ Health (2020).

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  • Night work
  • Evening work
  • Pain
  • Prospective
  • Rotating shift