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Migraine, tension-type headache and medication-overuse headache in a large population of shift working nurses: a cross-sectional study in Norway
  1. Bjørn Bjorvatn1,2,
  2. Ståle Pallesen2,3,
  3. Bente E Moen1,
  4. Siri Waage1,2,
  5. Espen Saxhaug Kristoffersen4
  1. 1 Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
  2. 2 Norwegian Competence Center for Sleep Disorders, Haukeland University Hospital, Bergen, Norway
  3. 3 Department of Psychosocial Science, University of Bergen, Bergen, Norway
  4. 4 Department of General Practice, University of Oslo, Oslo, Norway
  1. Correspondence to Dr Bjørn Bjorvatn; bjorn.bjorvatn{at}


Objectives To investigate associations between different types of headaches and shift work.

Design, participants and outcome measures Nurses with different work schedules (day work, two-shift rotation, night work, three-shift rotation) participated in a cohort study with annual surveys that started in 2008/2009. In 2014 (wave 6), a comprehensive headache instrument was included in the survey, in which 1585 nurses participated. Headaches were assessed according to the International Classification of Headache Disorders IIIb. Frequent headache (≥1 day per month), migraine, tension-type headache, chronic headache (headache >14 days per month) and medication-overuse headache (chronic headache + acute headache medication ≥10 days last month) comprised the dependent variables. Adjusted (for sex, age, percentage of full-time equivalent, marital status, children living at home) logistic regression analyses were conducted with work schedule, number of night shifts worked last year, number of quick returns (<11 hours in-between shifts) last year, shift work disorder and insomnia disorder as predictors.

Results Frequent headache, migraine and chronic headache were associated with shift work disorder (OR 2.04, 95% CI 1.62 to 2.59; 1.60, 1.21 to 2.12; 2.45, 1.25 to 4.80, respectively) and insomnia disorder (OR 1.79, 95% CI 1.43 to 2.23; 1.55, 1.18 to 2.02; 3.03, 1.54 to 5.95, respectively), but not with work schedule, number of night shifts or number of quick returns. Tension-type headache was only associated with >20 night shifts last year (OR 1.41, 95% CI 1.07 to 1.86). Medication-overuse headache was only associated with insomnia disorder (OR 7.62, 95% CI 2.48 to 23.41).

Conclusions We did not find any association between different types of headaches and work schedule. However, tension-type headache was associated with high number of night shifts. Nurses with sleep disorders (insomnia disorder and shift work disorder) reported higher prevalence of frequent headaches, migraine, chronic headache and medication-overuse headache (only insomnia) compared with nurses not having insomnia disorder and shift work disorder, respectively.

  • chronic headache
  • insomnia
  • shift work disorder
  • night work
  • quick returns

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  • Contributors BB contributed to the design of the study, data collection, data analysis, drafted the paper and approved the final version. SP, BEM and SW contributed to the design of the study, data collection, data analysis, revised the paper and approved the final version. ESK contributed to the design of the study, data analysis, revised the paper and approved the final version.

  • Funding The study received a grant for practical administration and data collection from the Western Norway Regional Health Authority (grant number 911386, no personal payment/salary). The Norwegian Nurses Organisation has provided grants to cover some of the the running expenses of the SUSSH study. The study was further partly funded from Nordforsk, Nordic Program on Health and Welfare (74809).

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval The Regional Committee for Medical and Health Research Ethics of Western Norway (REK-West, no 088.08).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data available.