DSE-Migraine-MA
Digital screen exposure and migraine burden: a systematic review and meta-analysis
Clinical Question
Is higher digital screen exposure associated with greater migraine or headache burden (risk, frequency, severity, disability) in adolescents and adults?
Study Overview
Objective
In adolescents and adults with migraine or primary headache, does higher digital screen exposure increase headache burden compared with lower exposure?
Study Summary
- Higher screen exposure raised odds of migraine/headache: pooled OR 1.60 (95% CI 1.38–1.86, p<0.001) from 10 studies (N=11,218), I2=60%.
- 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.
Patients per Arm
22 studies included (N=14,763 total); 10 studies pooled for OR meta-analysis (N=11,218)
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.
Design
Study Type: Systematic review and random-effects meta-analysis (DerSimonian–Laird) of observational (predominantly cross-sectional) and interventional studies
Randomization:
Blinding: Not applicable (dual independent screening, extraction, and risk-of-bias assessment)
Enrollment Period: No date restriction on included studies (published searches conducted for this review; database search dates as reported by authors)
Follow-up Duration: Not applicable (cross-sectional and observational data)
Centers: 0
Countries: multinational (studies from India, Egypt, Saudi Arabia, Bangladesh, Brazil, Turkey, France, Serbia, Denmark, Philippines, Germany, Italy, USA and others)
Sample Size: 14763
Analysis: PRISMA 2020–compliant; PROSPERO-registered (CRD420261404162). Databases searched: Embase, MEDLINE, PubMed, Scopus, Google Scholar. Two reviewers independently screened, extracted data, and assessed risk of bias using a modified Joanna Briggs Institute (JBI)/AHRQ checklist for cross-sectional and observational studies. Pooling threshold: ≥10 studies reporting OR with 95% CI for higher vs lower screen exposure — random-effects (DerSimonian–Laird) meta-analysis. Heterogeneity by I2 and Cochran's Q; small-study effects by Egger's regression; robustness by leave-one-out. Outcomes not amenable to pooling synthesised narratively. Certainty of evidence rated using GRADE.
Inclusion Criteria
- Observational (cross-sectional, case-control, cohort) or interventional studies
- Adolescent or adult participants with migraine or primary headache
- Quantifiable measure of digital screen exposure (screen time or device use)
- Reported migraine/headache outcomes (frequency, severity, disability) or secondary outcomes (sleep, quality of life, visual/ocular, psychiatric, musculoskeletal)
- English-language publication
- No date restriction on publication year
Exclusion Criteria
- Non-English publications
- Studies without a quantifiable screen-exposure measure
- Studies not reporting headache or migraine outcomes
- Case reports, narrative reviews, editorials, and conference abstracts without full data
- Duplicate publications
Arms
| Field | Higher screen exposure | Control |
|---|---|---|
| Intervention | Higher digital screen time / heavier device use (as dichotomised or top-category within each study) | Lower digital screen time / lighter device use (reference category within each study) |
| N | 0 | 0 |
Outcomes
| Outcome | Type | Control | Intervention | HR / OR / RR | P-value |
|---|---|---|---|---|---|
| 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) | Primary | Lower screen exposure (reference) | Higher screen exposure — pooled OR 1.60 | 1.6 | <0.001 |
| Adult subgroup pooled OR (higher vs lower screen exposure) | Secondary | Adults with lower screen exposure | Adults with higher screen exposure | 1.87 | |
| Paediatric / adolescent subgroup pooled OR (higher vs lower screen exposure) | Secondary | Paediatric/adolescent with lower screen exposure | Paediatric/adolescent with higher screen exposure | 1.46 | |
| Sleep disturbance associated with screen exposure (narrative synthesis) | Secondary | - | Reported in 18/22 studies (82%) | ||
| Reduced quality of life associated with screen exposure (narrative synthesis) | Secondary | - | Reported in 20/22 studies (91%) | ||
| Visual / ocular discomfort associated with screen exposure (narrative synthesis) | Secondary | - | Reported in 14/22 studies (64%) | ||
| Psychiatric comorbidity associated with screen exposure (narrative synthesis) | Secondary | - | Reported in 13/22 studies (59%) | ||
| Musculoskeletal symptoms associated with screen exposure (narrative synthesis) | Secondary | - | Reported in 11/22 studies (50%) | ||
| Two clinic-based comparative studies — headache frequency or severity by smartphone-use status | Secondary | No significant difference | No significant difference | ns | |
| Not applicable — observational meta-analysis of exposure/outcome associations; no interventional adverse events reported. | Safety | - | - |
Subgroup Analysis
Prespecified age-based subgroups showed directionally consistent effects: adults OR 1.87 (1.43–2.44); paediatric/adolescent OR 1.46 (1.24–1.72). Leave-one-out sensitivity analysis: pooled OR range 1.52–1.67 across sequential exclusion of each of the 10 pooled studies, confirming robustness.
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.
Funding
No funding was received for the conduct of this study.
Based on: DSE-Migraine-MA (Journal of Neurology, 2026)
Authors: Gowda N, Harish S, Tej G
Citation: J Neurol 2026;273:525. DOI: 10.1007/s00415-026-14062-y
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