Digital screen exposure and migraine burden: a systematic review and meta-analysis.

BACKGROUND

Digital screen exposure has risen sharply across paediatric, adolescent, and adult populations, and many individuals with migraine report that screen use triggers or worsens attacks.

OBJECTIVE

To systematically review and meta-analyse the association between digital screen exposure and migraine/headache burden, including frequency, severity, disability, and related secondary outcomes, and to summarise the proposed neurobiological mechanisms.

METHODS

This review was prospectively registered on PROSPERO (CRD420261404162) and conducted in accordance with PRISMA 2020 guidance. Embase, MEDLINE, PubMed, Scopus, and Google Scholar were searched without date restrictions for English-language observational and interventional studies of adolescents or adults with migraine or primary headache and a quantifiable measure of digital screen exposure. Two reviewers independently screened records, extracted data, and assessed risk of bias using a modified Joanna Briggs Institute (JBI)/AHRQ checklist for cross-sectional and observational studies. When ten or more studies reported an odds ratio (OR) with a 95% confidence interval (CI) for migraine or headache risk associated with higher versus lower screen exposure, a random-effects (DerSimonian-Laird) meta-analysis was performed. Heterogeneity was quantified with I2 and Cochran's Q; small-study effects were assessed with Egger's regression; and robustness was evaluated with a leave-one-out sensitivity analysis. Outcomes not amenable to pooling were synthesised narratively. Certainty of evidence was rated using GRADE.

RESULTS

Twenty-two studies (k = 22; total N = 14,763) met eligibility criteria. Ten studies (k = 10; N = 11,218) reporting OR data were pooled: higher screen exposure was associated with significantly greater odds of migraine/headache (pooled OR 1.60, 95% CI 1.38-1.86, p < 0.001), with moderate heterogeneity (I2 = 60%, Cochran's Q = 22.3, df = 9, p = 0.008) and a 95% prediction interval of 1.03-2.48. Associations were directionally consistent in adult (OR 1.87, 95% CI 1.43-2.44) and paediatric/adolescent (OR 1.46, 95% CI 1.24-1.72) subgroups, and were robust to sequential exclusion of any single study (range of pooled OR 1.52-1.67). Egger's test suggested possible small-study effects (intercept 3.71, p = 0.002). The remaining twelve studies, reporting correlation coefficients, regression betas, or between-group comparisons, narratively corroborated the association, although two clinic-based comparative studies found no significant difference in headache frequency or severity by smartphone-use status. Screen exposure was consistently associated with sleep disturbance (18/22 studies) and less consistently with visual/ocular discomfort (14/22), reduced quality of life (20/22), musculoskeletal symptoms (11/22), and psychiatric comorbidity (13/22). Mechanistic discussion across all 22 studies converged on blue light-mediated retinal ganglion cell activation, melatonin suppression and circadian disruption, and trigeminovascular/cortical hyperexcitability as the principal proposed pathways. Certainty of evidence for the primary outcome was rated low, reflecting risk of bias from self-reported, cross-sectional exposure measurement, residual confounding, and possible publication bias.

CONCLUSION

Digital screen exposure is associated with approximately 60% greater odds of migraine or headache, with biologically plausible mechanisms but low-certainty evidence drawn almost entirely from cross-sectional studies. Screen exposure should be regarded as a modifiable, clinically assessable factor in migraine care, while prospective, objectively measured, and interventional research is needed to establish causality and to test targeted mitigation strategies.

PROSPERO REGISTRATION: PROSPERO registration: CRD420261404162.