Current Smoking Linked to Higher Migraine Risk, Lower Tension-Type Headache Risk

Current cigarette smoking is linked to a higher risk for migraine but a lower risk for tension-type headache (TTH), according to study results published in The Journal of Headache and Pain.

Primary headache, including migraine, TTH, and cluster headache (CH), is among the most common neurologic conditions globally, significantly impacting public health and health care systems. Although tobacco use has been suspected to influence headache patterns, past studies have shown inconsistent results, prompting the need for a more robust analysis of this relationship.

Researchers performed a systematic review and meta-analysis searching PubMed and Scopus through February 2025. A total of 37 studies, representing 24,502 patients, were included. The researchers employed a random effects model to assess the prevalence of smoking and its association with different headache types and evaluate study quality with the Joanna Briggs Institute risk of bias tool. Meta-regression was conducted to determine whether age, sex, or publication year modified the observed associations.

The pooled data showed that smoking prevalence differed by headache subtype: 20% among those with migraine (95% CI, 16-24), 27% for migraine with aura (MwA; 95% CI, 17-27), 19% for TTH (95% CI, 7-34), and notably 65% for CH (95% CI, 55-76). Overall, smoking prevalence in individuals with primary headache was 32% (95% CI, 8-62).

Current smoking was significantly associated with an increased risk for migraine (odds ratio [OR], 1.29; 95% CI, 1.02-1.62; P =.034), while conversely linked to a reduced risk for TTH (OR, 0.78; 95% CI, 0.68-0.89; P <.001). No significant associations were found for CH (OR, 2.15; 95% CI, 0.41-11.27; P =.367) or between MwA and migraine without aura (OR, 1.06; 95% CI, 0.86-1.31; P =.600).

Former smoking was not significantly associated with migraine (OR, 0.80, 95% CI, 0.59-1.09; P =.152). Meta-regression showed no meaningful influence from age, sex, or publication year on these associations.

Limitations of the study include high heterogeneity across studies, variability in how smoking and headache types were assessed, and insufficient data for meta-regression in some subgroups such as CH and TTH.

“The direction of these associations remains unclear, so by no means is smoking advised to avoid TTH,” noted the researchers. They added, “There was no direct association between current smoking and CH, despite the fact that over half of patients with CH smoked. The influence of electronic cigarettes commonly used these days is not yet explored in primary headaches, despite their wide-spread use.”

This article originally appeared on Clinical Pain Advisor