Sleep, Stress and Migraine - an Observational and Training Study (MiSleepS)

Migraine Sleep Study (MiSleepS) - The Role of Sleep and Stress as a Trigger in Migraine

The MiSleepS study investigates how sleep disturbances and stress are linked to migraine attacks. Participants wear a device called a WHOOP band, which tracks sleep and body signals, and answer brief daily questions via a smartphone app about their sleep, stress levels, and migraine symptoms. The goal is to identify personal patterns that may contribute to migraine. Based on these insights, participants receive individualized recommendations to improve their sleep and daily routines - aiming to reduce migraine attacks in the long term without medication. The study is conducted at the University Hospital Zurich and is aimed at adults with episodic migraine.

Study Overview

• Status: Recruiting
• Conditions: Migraine; Stress; Migraine in Adults; Sleep Disorder (Disorder)
• Intervention / Treatment: Behavioral: Profile-based behavioral sleep and stress management

Detailed Description

Migraine is a widespread neurological disorder affecting more than one billion people worldwide, and is among the leading causes of disability, particularly in women. It is characterized by episodic or chronic headaches and often accompanied by nausea, photophobia, and cognitive impairment. Despite advances in pharmacological therapies - such as the advent of CGRP antagonists - a large proportion of patients remain undertreated or refractory to standard interventions. Critically, migraine is influenced by multiple behavioral and environmental triggers, among which sleep disturbances and stress are consistently among the most frequently reported and most modifiable. However, their complex and often bidirectional interactions with migraine are still not fully understood, and most available research is limited by methodological constraints, including short observation periods, retrospective data, and insufficient attention to sex and gender variables.

The Migraine Sleep Study (MiSleepS) is a prospective, two-phase clinical study aiming to investigate the role of sleep, circadian rhythm, and stress as dynamic triggers of migraine and to evaluate the effectiveness of individualized, non-pharmacological behavioral interventions. Conducted at the University Hospital Zurich, this monocentric study will combine high-resolution physiological data captured via the WHOOP 5.0 wrist-worn wearable device with real-time, ecological momentary assessments (EMA) collected through the SEMA3 smartphone app. These dual digital tools enable continuous monitoring of key variables such as sleep duration, sleep architecture, heart rate variability, perceived stress, and migraine occurrence and severity.

Participants will undergo a five-week observational phase (phase A), during which their natural sleep-stress-migraine interactions will be captured without interference. An interim analysis will be conducted to identify individual behavioral and circadian profiles, including insomnia-like patterns, sleep deprivation, social jetlag, and chronotype mismatch. Based on these results, participants will be stratified into clusters and assigned a tailored behavioral plan to address their specific profile. In the subsequent six-week intervention phase (phase B), participants will implement these behavioral strategies, supported by remote follow-ups and daily app-based tracking. The primary endpoint will be the change in monthly migraine days, while secondary endpoints include migraine severity, sleep quality, stress levels, and adherence to recommendations.

To control for observation-related confounding - such as the Hawthorne effect - a run-in cohort of the first ten participants will follow a modified protocol. While they undergo the same assessment and tracking procedures, they will not receive any behavioral recommendations in phase B. This approach allows for differentiation between improvements due to heightened self-awareness and those attributable to the targeted intervention itself.

The study further aims to examine sex- and gender-related differences in migraine pathophysiology and response to behavioral interventions, using validated tools such as the Stanford Gender-Related Variables for Health Research (GVHR) score (Nielsen et al., 2021). By integrating physiological, psychological, and gender-related dimensions, MiSleepS aspires to develop a more individualized understanding of migraine and to explore scalable, low-risk, non-pharmacological treatment strategies that can be implemented in clinical practice.

• Study Type: Interventional
• Enrollment (Estimated): 80
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Susanne Wegener; Phone Number: +41 44 255 55 11; Email: susanne.wegener@usz.ch
• Study Contact Backup: Name: Marie Therese Kleinsorge; Phone Number: +41 44 255 55 11; Email: marie.kleinsorge@usz.ch

Study Locations

• Switzerland
  • Zurich, Switzerland, 8091
    • Recruiting
    • University Hospital Zurich, Department of Neurology
    • Contact: Susanne Wegener; Phone Number: +41 44 255 55 11; Email: susanne.wegener@usz.ch
    • Contact: Marie Therese Kleinsorge; Phone Number: +41 44 255 55 11; Email: marie.kleinsorge@usz.ch

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Adults aged between 18 and 65 years
• Diagnosis of episodic migraine according to The International Classification of Headache Disorders (ICHD-3) criteria confirmed by our headache specialists
• 4 to 14 headache days per month (mean value based on the 3 months prior to study enrollment)
• Ability to give informed consent and to adhere to the study protocol
• Sufficient German language comprehension to follow the study procedures and answer all questions related to the study outcomes
• Stable migraine medication regimen for the past 3 months and throughout the study period

Exclusion Criteria:

• Diagnosis of sleep disorders that could interfere with the sleep intervention, such as obstructive sleep apnea with an apnea-hypopnea index (AHI) > 15, Restless Legs Syndrome, frequent (i.e. weekly) Non-rapid eye movement (NREM) sleep parasomnia, REM Behavior Disorder (RBD)
• Current diagnosis of a psychiatric disorder that is inadequately treated or therapy-resistant and may interfere with study participation or adherence to study procedures (this includes, but is not limited to: schizophrenia, schizoaffective disorder, bipolar disorder (type I), post-traumatic stress disorder with active symptoms, or major depressive disorder with ongoing functional impairment despite treatment). Diagnosis must be confirmed by clinical history or treating physician.
• Regular use of benzodiazepines and other central nervous system (CNS)-depressant substances (self-reported)
• Concomitant steroid medication (self-reported)
• Known or suspected alcohol, drug or medication abuse (i.e. > 0.5 l wine or 1 l beer per day)
• Inability to follow the procedures of the study (e.g., due to language problems, cognitive deficits, instable home situation)
• Concurrent participation in another study involving drug and behavioral interventions within 3 months prior to and during the present study, as well as participation in an ongoing study with data collection through SEMA3
• Planned medical intervention of substantial relevance requiring hospitalization for more than 24 hours (e.g. surgery) during intervention (routine assessments, e.g. check-ups will be allowed)
• Shift work with working during the night
• Travelling more than 2 time zones in the last month before the observation or intervention periods or during the study
• Persons who are pregnant or breastfeeding

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Other
• Allocation: N/A
• Interventional Model: Single Group Assignment
• Masking: None (Open Label)

Number of Arms

1

Arms and Interventions

Participant Group / Arm

Intervention / Treatment

Experimental: Personalized Behavioral Intervention Arm; N=70 participants undergo a 5-week observational phase (phase A) with continuous wearable tracking and daily app-based self-reporting. After an interim analysis, they are assigned to a sleep/stress-related behavioral profiles. In the following 6-week intervention phase (phase B), they receive personalized behavioral recommendations tailored to their profile and implement them with ongoing digital monitoring. The first 10 participants (run-in group) follow the same protocol but do not receive personalized interventions in phase B. This group serves as a control to distinguish behavioral effects of the intervention from those caused by increased self-monitoring or study participation alone (Hawthorne effect).

Behavioral: Profile-based behavioral sleep and stress management; After completion of the 5-week observational phase (phase A), the study team will conduct an interim analysis integrating WHOOP biometric data and SEMA3 self-reports on migraine, sleep, and stress. The aim is to identify individual sleep-stress patterns linked to migraine activity. Based on predefined criteria, participants will be assigned to one of four behavioral profiles: insomnia-like, sleep deprivation, social jetlag, or circadian misalignment. Mixed or unclassified cases will be grouped separately. All participants receive general behavioral recommendations on sleep hygiene, scheduling, and stress management. WHOOP-based personalized tips (e.g., optimal sleep windows, recovery days) will be encouraged. Profile-based participants also receive targeted prioritization of interventions most relevant to their sleep-migraine pattern, including techniques such as rhythm stabilization, relaxation training, or strategic light exposure.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Decrease in the number of migraine days (6 weeks)	The primary endpoint is the change in the number of migraine days per month from phase A (baseline) to the end of phase B, following 6 weeks of intervention. A reduction of 30% in self-reported monthly migraine days is defined as the primary outcome measure.	From phase A (baseline) to the end of phase B (6 weeks of intervention).

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Association between total sleep time and migraine onset	Correlation between objectively measured total sleep time (hours, derived from wearable device data) and the occurrence of migraine onset (yes/no), assessed using daily entries.	Phase A (5 weeks).
Association between sleep latency and migraine onset	Correlation between sleep latency (minutes, derived from wearable device data) and the occurrence of migraine onset (yes/no), assessed using daily entries.	Phase A (5 weeks).
Association between sleep-wake time variability and migraine onset	Correlation between variability in sleep-wake timing (derived descriptively from wearable device data) and the occurrence of migraine onset (yes/no), assessed using daily entries.	Phase A (5 weeks).
Association between recovery score and migraine onset	Correlation between recovery scores (as calculated by the wearable device application) and the occurrence of migraine onset (yes/no), assessed using daily entries.	Phase A (5 weeks).
Association between perceived stress and migraine onset	Correlation between perceived stress measured daily using the Stress Numeric Rating Scale-11 (Stress NRS-11) and the occurrence of migraine onset (yes/no).	Phase A (5 weeks).
Difference in total sleep duration between nights with and without migraine attacks	Mean difference in total sleep duration (hours), derived from wearable device data and daily entries, comparing nights with reported migraine attacks (yes) versus nights without migraine attacks (no), as recorded in the SEMA3 app.	Phase A (5 weeks)
Difference in sleep quality between nights with and without migraine attacks	Mean difference in subjective sleep quality, assessed via daily entries, comparing nights with reported migraine attacks (yes) versus nights without migraine attacks (no).	Phase A (5 weeks)
Difference in light, deep, and REM-sleep proportion between nights with and without migraine attacks	Mean difference in the proportion of time spent in light sleep, deep sleep, and REM-Sleep (% per night), derived from wearable device data, comparing nights with reported migraine attacks (yes) versus nights without migraine attacks (no).	Phase A (5 weeks)
Change in subjective sleep quality from baseline to end of intervention	Mean change in subjective sleep quality measured using a validated questionnaire (Pittsburgh Sleep Quality Index, PSQI) and daily entries in the SEMA3 app, comparing the observational phase (Phase A, baseline) to the end of the intervention phase (Phase B).	From phase A (baseline) to the end of phase B (intervention, 6 weeks).
Change in total sleep duration from baseline to end of intervention	Mean change in total sleep duration (hours per night), derived from wearable device data, comparing the observational phase (Phase A, baseline) to the end of the intervention phase (Phase B).	From phase A (baseline) to the end of phase B (intervention, 6 weeks).
Change in sleep consistency score from baseline to end of intervention	Mean change in sleep consistency score, derived from wearable device data, comparing the observational phase (Phase A, baseline) to the end of the intervention phase (Phase B).	From phase A (baseline) to the end of phase B (intervention, 6 weeks).
Change in sleep onset variability from baseline to end of intervention	Mean change in variability of sleep onset timing, derived from wearable device data, comparing the observational phase (Phase A, baseline) to the end of the intervention phase (Phase B).	From phase A (baseline) to the end of phase B (intervention, 6 weeks).
Change in perceived stress from baseline to end of intervention	Mean change in perceived stress measured daily using the Stress Numeric Rating Scale-11 (0-10) via the SEMA3 app, comparing the observational phase (Phase A, baseline) to the end of the intervention phase (Phase B).	From phase A (baseline) to the end of phase B (intervention, 6 weeks).
Decrease in the number of migraine days (3 months)	Change in the number of migraine days per month from phase A (baseline) to the end of the study (3 months) (outcome measures: 30% reduction in the number of self-reported monthly migraine days before vs. after the intervention)	From phase A (baseline) to the end of the study (3 months)
Change in migraine severity from baseline to end of intervention	Mean change in migraine severity, measured as average daily Numeric Rating Scale (NRS; 0-10) scores recorded in the SEMA3 app, comparing the observational phase (Phase A, baseline) to the end of the intervention phase (Phase B). Analysis includes only participants reporting migraine episodes in both phases.	From phase A (baseline) to the end of phase B (intervention phase)
Change in migraine attack duration from baseline to end of intervention	Mean change in migraine attack duration, measured as mean hours per episode based on participant self-report in the SEMA3 app, comparing the observational phase (Phase A, baseline) to the end of the intervention phase (Phase B). Analysis includes only participants reporting migraine episodes in both phases.	From phase A (baseline) to the end of phase B (intervention phase)
Change in migraine severity from baseline to 3-month follow-up	Mean change in migraine severity, measured as average daily Numeric Rating Scale (NRS; 0-10) scores recorded in the SEMA3 app, comparing the observational phase (Phase A, baseline) to the end of the study (3-month follow-up). Analysis includes only participants reporting migraine episodes in both periods.	From phase A (baseline) to 3-month follow-up
Change in migraine attack duration from baseline to 3-month follow-up	Mean change in migraine attack duration, measured as mean hours per episode based on participant self-report in the SEMA3 app, comparing the observational phase (Phase A, baseline) to the end of the study (3-month follow-up). Analysis includes only participants reporting migraine episodes in both periods.	From phase A (baseline) to 3-month follow-up

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Identification of participant subgroups based on baseline sleep, stress, and migraine characteristics	Identification of distinct participant subgroups using multivariate statistical techniques (e.g., cluster analysis, latent class modeling) based on baseline profiles including wearable-derived sleep metrics, daily perceived stress, and migraine frequency and severity.	Baseline (ende of Phase A)
Association between baseline subgroup classification and intervention response	Association between participant subgroup membership (derived from baseline sleep, stress, and migraine profiles) and response to the behavioral intervention, defined as change in monthly migraine days and responder status (≥30% reduction).	From phase A (baseline) to the end of the study (3-month follow-up).
Sex and gender differences in sleep-stress-migraine associations	To assess whether sex (biological) and gender (psychosocial) influence the association between sleep, circadian rhythm variables, perceived stress, and migraine burden (phase A). Sex will be recorded as a binary variable (male/female). Gender will be assess using The Stanford Gender-Related Variables for Health Research (GVHR), which reflects psychosocial gender traits (e.g., role orientation, identity, stress coping) and allows continuous, multidimensional assessment beyond binary sex. Outcome measures: Subgroup comparisons of correlations between: wearable-derived sleep and recovery data (e.g. total sleep time, variability, heart rate variability (HRV)), daily perceived stress (Stress NRS-11), migraine symptoms (from SEMA3 data: frequency, intensity, NRS, duration in hours).; Moderation analyses using GVHR (Measurement tools: WHOOP biometric data, migraine symptom logs (SEMA3), GVHR, Stress NRS-11)	Phase A (5 weeks)
Sex and gender differences in response to the personalized behavioral intervention	To evaluate whether sex and gender influence the effectiveness of the personalized behavioral intervention delivered in Phase B. Effectiveness is defined by change in migraine frequency, severity, and stress levels from Phase A to Phase B. Outcome measures: Sex- and gender-based subgroup analyses of: change in monthly migraine days, change in the migraine severity (NRS) and duration (hours), and change in perceived stress (Stress NRS-11, PSS-10).; Interaction effects (sex x intervention; gender score (GVHR x intervention). (Measurement tools: WHOOP biometric data, migraine symptom logs (SEMA3), GVHR, Stress NRS-11, PSS-10)	Pre-post comparison: phase A vs. phase B
Adherence rate to behavioral intervention recommendations	Adherence to prescribed behavioral recommendations, measured as the percentage of completed adherence logs relative to expected entries over the intervention period.	Phase B (intervention phase) through 3-month follow-up
Participant-reported feasibility, usefulness, and perceived benefit of the intervention	Assessment of participant-reported feasibility, usefulness, and perceived benefit of the behavioral intervention, measured using a standardized user feedback questionnaire and summarized using descriptive statistics and thematic analysis of qualitative responses.	End of Phase B (intervention phase) and 3-month follow-up

Collaborators and Investigators

• Sponsor: Susanne Wegener
• Investigators: Principal Investigator: Susanne Wegener, University Hospital Zurich, Department of Neurology

Study record dates

Study Major Dates

• Study Start (Estimated): May 18, 2026
• Primary Completion (Estimated): April 30, 2027
• Study Completion (Estimated): July 31, 2027

Study Registration Dates

• First Submitted: June 7, 2025
• First Submitted That Met QC Criteria: May 3, 2026
• First Posted (Actual): May 7, 2026

Study Record Updates

• Last Update Posted (Actual): May 7, 2026
• Last Update Submitted That Met QC Criteria: May 3, 2026
• Last Verified: July 1, 2025

More Information

Terms related to this study

• Keywords: sleep hygiene; migraine; stress management; behavioral therapy; migraine triggers; non-medical prophylaxis
• Additional Relevant MeSH Terms: Neurologic Manifestations; Brain Diseases; Central Nervous System Diseases; Nervous System Diseases; Mental Disorders; Headache Disorders, Primary; Headache Disorders; Pathological Conditions, Signs and Symptoms; Behavior; Signs and Symptoms; Health Behavior; Migraine Disorders; Sleep Wake Disorders; Sleep Hygiene
• Other Study ID Numbers: 2025-01186

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: UNDECIDED

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No