Background: Recent studies have found a strong relationship between tobacco smoking and headache pain. It remains unclear whether smoking behavior leads to headache or visa versa, mainly due to the cross-sectional nature of the majority of this research.
Objective: To help clarify the direction of the relation between smoking and frequent headaches in a representative cohort study.
Design and methods: Members of the Dunedin Multidisciplinary Health and Development Study (N=980) were asked about their cigarette smoking and headache history at ages 11 and 13 (childhood), age 15 (mid-adolescence), and age 26 (adulthood). Both cross-sectional and longitudinal associations between smoking and headache status were examined using logistic regression.
Results: During mid-adolescence, the likelihood of frequent headaches doubled for smokers relative to nonsmokers (OR: 2.16, 95% CI: 1.39-3.35). Smoking did not increase the risk of developing headaches in adulthood, however. In contrast, individuals who suffered from frequent headaches during mid-adolescence were 2 times more likely to smoke in adulthood than those without headache (OR: 2.20, 95% CI: 1.3-3.7), after controlling for sex and family socioeconomic status. Attempts to quit smoking were significantly more difficult for migraine sufferers with a history of headache than for those with tension-type headache.
Conclusions: Frequent headaches during mid-adolescence appear to increase the risk of daily smoking in adolescence and adulthood. These individuals also have a more difficult time quitting than their headache-free peers.