Gary DeNelsky, PhD, started smoking when he was 16 years old. By college, he was burning through a pack a day, and in graduate school he began to experience severe headaches. Concerned, he consulted a neurologist who did a thorough neurological exam but could not establish a cause for his headaches.
DeNelsky, a psychologist emeritus at the Cleveland Clinic in Cleveland, Ohio, finally stopped smoking at age 40 after many failed attempts. Several months after he quit, he noticed that his headaches were both less frequent and less intense. He became convinced that cigarette smoke was to blame for the years of head pain and went on to found a smoking cessation program at the Cleveland Clinic, which he directed until 2001. Today at age 73, DeNelsky still experiences headaches that he believes are triggered by second-hand smoke.
“I was recently in Las Vegas in one of the smoky casinos and couldn’t stay in the room more than 20 minutes without getting a headache,” DeNelsky says.
Many people who suffer from headaches are equally convinced of the role of cigarette smoke in their headaches. In a Nov. 2005 survey by the National Headache Foundation (NHF), 34 percent of respondents reported that smoke triggered their headaches, and 38 percent of respondents said that they avoid smoky environments.
The components of cigarettes and their side effects can trigger several activities in the body that result in headaches. To avoid new headaches, it is important to decrease smoking or quit completely.
Identifying the Trigger
Research has shown that some sort of connection exists between cluster headache and smoking, and age and smoking. A study published in the Jan. 2012 issue of the journal Headache found that 73 percent of individuals with cluster headaches report a history of smoking. Further, smokers under the age of 40 with headaches occurring more than 14 days a month have a higher association between smoking and headache, according to an article published in the Nov. 2006 issue of the European Journal of Neurology (EJN).
Unfortunately, it is unclear at this point whether there is a direct link between cluster headache and smoking. People with cluster headache also tend to drink alcohol, which further clouds the issue. Frederick G. Freitag, DO, medical director and director of headache medicine research for the Comprehensive Headache Center at Baylor Health Care System in Dallas and a member of the NHF Board of Directors, refers to a study in the Apr. 1992 issue of the journal Headache. In this study, cluster patients reported that alcohol, not tobacco intake, was the trigger for cluster attacks.
What researchers do know is that certain components of cigarettes cause side effects—and it is these side effects that can induce headaches. According to the EJN article:
- Carbon monoxide, a component of cigarette smoke, provokes a lack of oxygen that can trigger headaches.
- Smoking can decrease the efficacy of headache medications.
- Smoking can decrease monoamine oxidase (MAO) activity; low MAO activity is thought to be linked to an increase in headaches. Further, according to research published in a 1994 issue of the journal Stroke, nitric oxide (released when nicotine enters the bloodstream) promotes dilation of arteries that typically accompanies cortical spreading depression, the activity that triggers a migraine.
Stop Smoking to Avoid Headaches
If you experience headaches, particularly cluster head- aches, specialists advise that you make every effort to stop smoking. This precaution can be easier said than done, so keep these two tips in mind:
- Be careful about which smoking cessation tools you use. Some medications that serve as cessation aids, including Champix® (varenicline) and Zyban® (bupropion), list headache as a possible side effect. If medications are a trigger, consider alternatives such as hypnosis, biofeedback and acupuncture. “The vast majority of people who quit do it on their own with virtually no pharmaceutical assistance,” DeNelsky says.
- Withdraw slowly. Going cold turkey can create nicotine-withdrawal headaches. “You may feel worse before you feel better,” says Robert A. Nicholson, PhD, clinical psychologist at Mercy Clinic Headache Center in St. Louis, Mo. But remember that side effects will diminish with time.
It is important to start the process and to quit completely in order to relieve headaches and other smoking-related maladies. “There is no way to quit smoking without effort,” DeNelsky says. “It is a journey and you have to commit yourself to that journey.”
NHF’s Smoking Survey
The National Headache Foundation (NHF) conducted a survey in 2005 to learn more about the correlation between smoking and headache. The results showed that:
- Of those who reported smoking, 98 percent smoked cigarettes (as opposed to cigars or pipes) and 54 percent smoked 11 or more cigarettes per day.
- Of respondents, 34 percent said smoke was a headache trigger.
- Of former smokers, 53 percent reported quitting due to concerns about cancer.
- Of former smokers, 82 percent reported their headaches did not increase in severity while quitting.
