DSE-Migraine-MA
(2026)Objective
In adolescents and adults with migraine or primary headache, does higher digital screen exposure increase headache burden compared with lower exposure?
Study Summary
• Effect held in adults (OR 1.87, 95% CI 1.43–2.44) and paediatric/adolescents (OR 1.46, 95% CI 1.24–1.72); robust to leave-one-out (OR 1.52–1.67).
• Certainty of evidence rated LOW (GRADE) with possible small-study effects (Egger intercept 3.71, p=0.002) and all data from cross-sectional studies.
Intervention
Exposure measure: higher vs lower digital screen time (smartphone, computer, TV, tablet use) — observational; no intervention.
Inclusion Criteria
Observational or interventional studies in adolescents or adults with migraine or primary headache, English-language, with a quantifiable measure of digital screen exposure and headache/migraine outcomes; no date restriction.
Study Design
Arms: Higher screen exposure vs Lower screen exposure (as defined per included study)
Patients per Arm: 22 studies included (N=14,763 total); 10 studies pooled for OR meta-analysis (N=11,218)
Outcome
• Subgroups: adults OR 1.87 (1.43–2.44); paediatric/adolescent OR 1.46 (1.24–1.72).
• Sensitivity: leave-one-out pooled OR range 1.52–1.67 (robust).
• Publication bias: Egger's regression intercept 3.71, p=0.002 (suggestive of small-study effects).
• Narrative secondary outcomes across 22 studies: sleep disturbance associated in 18/22; reduced quality of life 20/22; visual/ocular discomfort 14/22; psychiatric comorbidity 13/22; musculoskeletal symptoms 11/22.
• Two clinic-based comparative studies found no significant difference in headache frequency or severity by smartphone-use status.
• GRADE certainty of evidence for the primary outcome: LOW.
Bottom Line
In a random-effects meta-analysis of 10 studies (N=11,218), higher digital screen exposure was associated with a ~60% greater odds of migraine or headache (pooled OR 1.60, 95% CI 1.38–1.86, p<0.001), with directionally consistent adult and paediatric subgroup effects and robustness to leave-one-out. Overall certainty of evidence was low (GRADE), reflecting cross-sectional exposure ascertainment, residual confounding, and possible small-study effects; screen exposure should be regarded as a modifiable factor to assess in migraine care, pending prospective and interventional confirmation.
Major Points
- 22 studies (N=14,763) met eligibility criteria; 10 studies (N=11,218) with OR data were pooled by random-effects (DerSimonian–Laird) meta-analysis.
- Primary result: higher vs lower screen exposure — pooled OR 1.60 (95% CI 1.38–1.86, p<0.001); heterogeneity I2=60%, Cochran Q=22.3, df=9, p=0.008; 95% prediction interval 1.03–2.48.
- Adult subgroup pooled OR 1.87 (95% CI 1.43–2.44); paediatric/adolescent subgroup OR 1.46 (95% CI 1.24–1.72) — direction consistent across age groups.
- Leave-one-out sensitivity analysis: pooled OR ranged 1.52–1.67, indicating no single study drove the pooled estimate.
- Egger's regression suggested small-study effects (intercept 3.71, p=0.002); certainty of evidence rated LOW (GRADE).
- Two clinic-based comparative studies found no significant difference in headache frequency or severity by smartphone-use status — the only null narrative signals.
- Consistent secondary associations across the full 22-study set: sleep disturbance 18/22, reduced quality of life 20/22, visual/ocular discomfort 14/22, psychiatric comorbidity 13/22, musculoskeletal symptoms 11/22.
- Mechanistic convergence across included studies: blue light–mediated retinal ganglion cell activation, melatonin suppression / circadian disruption, and trigeminovascular / cortical hyperexcitability.
Study Design
- Study Type
- Systematic review and random-effects meta-analysis (DerSimonian–Laird) of observational (predominantly cross-sectional) and interventional studies
- Randomization
- No
- Blinding
- Not applicable (dual independent screening, extraction, and risk-of-bias assessment)
- Sample Size
- 14763
- Follow-up
- Not applicable (cross-sectional and observational data)
- Countries
- multinational (studies from India, Egypt, Saudi Arabia, Bangladesh, Brazil, Turkey, France, Serbia, Denmark, Philippines, Germany, Italy, USA and others)
Primary Outcome
Definition: Pooled odds of migraine or headache with higher vs lower digital screen exposure (random-effects DerSimonian–Laird meta-analysis of 10 studies, N=11,218)
| Control | Intervention | HR/OR | P-value |
|---|---|---|---|
| Lower screen exposure (reference) | Higher screen exposure — pooled OR 1.60 | 1.6 (1.38-1.86) | <0.001 |
Limitations & Criticisms
- Almost all included studies were cross-sectional — cannot establish temporality or causality between screen exposure and migraine/headache.
- Screen exposure was self-reported and often heterogeneously categorised across studies, introducing exposure-measurement error.
- Moderate statistical heterogeneity (I2=60%) and a wide 95% prediction interval (1.03–2.48) indicate the underlying true effect could plausibly be small in some populations.
- Egger's test intercept 3.71 (p=0.002) suggests small-study effects and possible publication bias — smaller studies with larger reported effects are over-represented.
- Residual confounding (sleep quality, mental health, socioeconomic status, concurrent digital-media content) was inconsistently addressed across included studies.
- Two clinic-based comparative studies were null, contrasting with the pooled positive effect — highlighting setting-specific confounding.
- Language restriction to English may have excluded relevant regional evidence.
- GRADE overall certainty of evidence for the primary outcome was rated LOW, reflecting these limitations.
- Narrative outcomes (sleep, QOL, visual, psychiatric, musculoskeletal) were tallied qualitatively; the review did not pool these secondary outcomes quantitatively.
Citation
J Neurol 2026;273:525. DOI: 10.1007/s00415-026-14062-y