Cigarette smoke contains carbon monoxide, a known headache trigger, and nicotine has been shown to reduce the effectiveness of many, if not most, headache medications by interfering with the liver's ability to break down (metabolize) these drugs. Smoking can also reduce the benefits of nonpharmacological treatments, such as exercise and relaxation.
A recent survey of over 1,000 people in the Detroit area found that 33% of migraine sufferers use tobacco. This is almost twice the rate of cigarette smoking found in those who did not have migraine. One study at a headache clinic found that smokers had more intense headaches (as well as more depression and other physical symptoms) than nonsmokers. In summary, continuing to smoke can place any headache treatment program in serious jeopardy.
Can smoking contribute to headaches?
Current scientific evidence suggests that cigarette smoke may contribute substantially to headache disorders. There are several mechanisms by which this may occur:
- Smoking may cause headache by raising carbon monoxide levels in the blood and brain, in much the same way as a faulty furnace or a car running in an enclosed garage can provoke headache.
- Reduced oxygenation will also cause headache and deprive tissues of needed oxygen which may be relevant to other pain-related illness.
- Nicotine itself has a toxic effect on the brain and also alters liver metabolism which has an adverse effect on many of the drugs that are used to control headaches.
It is our recommendation that all patients experiencing recurrent headache should discontinue cigarette smoking as part of their treatment program. We also strongly encourage a smoke-free environment in the home and workplace.