Shifts with Nights and Migraine Prevalence Among Nurses: A Systematic Review and Meta-Analysis

TL;DR

A review of studies on nurses found no strong evidence that night shifts increase migraine prevalence compared to day-only schedules.

Contribution

This is the first nurse-specific systematic review and meta-analysis on the relationship between night shifts and migraine prevalence.

Findings

Night-inclusive schedules were not significantly associated with higher migraine prevalence compared to day-only schedules.

Secondary comparisons of night-work intensity showed inconclusive results due to limited data and inconsistent definitions.

The evidence base is small and heterogeneous, making it difficult to draw firm conclusions or policy recommendations.

Abstract

What are the main findings?
In a nurse-specific systematic review and meta-analysis (4 observational studies; total N = 3843, analyzable N = 3323), night-inclusive schedules (fixed nights and/or rotating shifts including nights) were not associated with a statistically significant difference in 1-year migraine prevalence versus day-only/non-night schedules (pooled PR = 0.95, 95% CI 0.82–1.10; I2 = 0%).Secondary night-work intensity comparisons were inconclusive (high vs. low: PR = 1.24, 95% CI 0.46–3.36; high vs. zero nights: PR = 0.85, 95% CI 0.38–1.93), with non-harmonized exposure thresholds and few contributing studies limiting precision and consistency.

In a nurse-specific systematic review and meta-analysis (4 observational studies; total N = 3843, analyzable N = 3323), night-inclusive schedules (fixed nights and/or rotating shifts including nights) were not associated with a statistically significant difference in 1-year migraine prevalence versus day-only/non-night schedules (pooled PR = 0.95, 95% CI 0.82–1.10; I2 = 0%).

Secondary night-work intensity comparisons were inconclusive (high vs. low: PR = 1.24, 95% CI 0.46–3.36; high vs. zero nights: PR = 0.85, 95% CI 0.38–1.93), with non-harmonized exposure thresholds and few contributing studies limiting precision and consistency.

What are the implications of the main findings?
Current nurse-specific evidence does not support strong conclusions or roster-policy recommendations based on migraine prevalence alone, because the evidence base is small, mostly cross-sectional, and relies on heterogeneous exposure definitions and crude PRs.Future research should use prospective designs that distinguish fixed night work from rotating-with-nights schedules and measure shift-pattern features (e.g., irregularity, quick returns, consecutive nights), while assessing sleep/circadian mediators and migraine outcomes beyond prevalence (incidence, attack frequency, chronification, disability, medication use).

Current nurse-specific evidence does not support strong conclusions or roster-policy recommendations based on migraine prevalence alone, because the evidence base is small, mostly cross-sectional, and relies on heterogeneous exposure definitions and crude PRs.

Future research should use prospective designs that distinguish fixed night work from rotating-with-nights schedules and measure shift-pattern features (e.g., irregularity, quick returns, consecutive nights), while assessing sleep/circadian mediators and migraine outcomes beyond prevalence (incidence, attack frequency, chronification, disability, medication use).

Background: Fixed night work and rotating schedules including nights may contribute to migraine via sleep disruption and circadian misalignment, but evidence is inconsistent and definitions vary. This systematic review and meta-analysis compared past-year migraine prevalence in nurses working night-inclusive schedules versus day-only or non-night schedules. Methods: Following PRISMA 2020 and registered in PROSPERO (CRD420261304288), we searched PubMed, Scopus, Web of Science, CINAHL, and the Cochrane Library from inception to 3 February 2026 (English/Spanish). Observational studies in nurses (≥18 years) reporting past-year migraine prevalence by shift pattern were eligible. All included studies assessed past-year prevalence; pooled PRs reflect 1-year prevalence. Crude prevalence ratios (PRs) were calculated from contingency tables and pooled quantitatively. Risk of bias was assessed with the JBI prevalence checklist. Results: We identified 54 records; 4 studies were included (N = 3843) of which 3323 participants contributed to the comparative meta-analysis because complete disaggregated data were available to construct contingency tables. The pooled association between night-inclusive schedules and migraine prevalence was not statistically significant (PR = 0.95, 95% CI 0.82–1.10; I2 = 0%). Secondary intensity contrasts were inconclusive (high vs. low: PR = 1.24, 95% CI 0.46–3.36; high vs. zero nights: PR = 0.85, 95% CI 0.38–1.93). Conclusions: Current nurse-specific evidence does not show a statistically significant difference in migraine prevalence between night-inclusive and non-night schedules; however, the small evidence base and limited generalizability preclude firm conclusions. Future longitudinal studies are needed to clarify this association.

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