Migraine Risk Rises With Unexpectedness of Daily Experiences: Daily Dose

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On November 17, 2025, we reported on a study published in JAMA Network Open that examined the association between surprisal and future headache attacks.

The study

Researchers conducted a cohort study of 109 individuals with migraine who completed diary entries of potential migraine triggers and migraine attacks within 12 and 24 hours after trigger exposure twice daily for up to 28 days. The diary entries captured exposure to behavioral, emotional, and environmental triggers including sleep patterns, mood states measured by the Profile of Mood States Short Form, food and drink intake, daily stressors from the Daily Stress Inventory, and weather influences.

Primary outcomes were the occurrence of a headache attack within 12 and 24 hours of trigger exposure (0 = no attack; 1 = attack). A headache attack was defined as any self-reported headache with pain greater than 0 on a 0–10 scale, accompanied by any secondary symptoms (eg, photophobia, phonophobia).

The investigators calculated surprisal scores using within-person empirical probability distributions, reflecting how atypical each day's experiences were compared to that individual's typical patterns. The total surprisal score summed item-level surprisal values and was scaled by the number of items to yield a mean surprisal score per item, expressed in "bits" of information.

The findings

Higher surprisal scores, which reflected unexpected physiological, emotional, or environmental changes, were significantly associated with increased odds of a headache within both 12 hours (OR 1.86; 95% CI, 1.12-3.08) and 24 hours (OR 2.15; 95% CI, 1.44-3.20). For each “bit” increase in surprisal score, the odds of a future headache rose 86% at 12 hours (OR, 1.86; 95% CI, 1.12-3.08; P =.02) and 115% at 24 hours (OR, 2.15; 95% CI, 1.44-3.20; P <.001). Sensitivity analyses showed slightly attenuated but still significant effects.

Authors’ comments

“Incorporating surprisal into digital tools may improve personalized prevention strategies, moving beyond static trigger lists to a dynamic, context-aware model of migraine self-management.”

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