The Relationship Between Smoking & Migraine

We all know smoking is bad for our health and greatly increases our risk of lung cancer. However, your lungs are not the only organs that suffer when you smoke. The nicotine in tobacco products has a wide range of negative effects on the body. It increases your risk of heart disease, damages the kidneys, increases your risk of pancreatic cancer, and it might be making your migraines worse, too!

The relationship between smoking and migraine — and between smoking and headaches in general — is complex. Keep reading, and we’ll explore that relationship and what it means for you as a migraine patient.

Smoking as a Precipitating Factor to Migraines

In the early 2000s, the relationship between smoking and migraines was still poorly understood. There were even some researchers who felt that smoking might decrease migraines by lowering stress and anxiety levels. However, in more recent years, the evidence has become more clear: tobacco use is a precipitating factor in migraine attacks.

Does this mean that smoking causes migraines? Not exactly. The root causes of migraine are not fully understood yet, even by the most advanced researchers. Smoking will not turn someone into a migraine sufferer who would not otherwise be prone to migraines. (Although it might give them headaches!) Instead, describing smoking as a “precipitating factor” means that it contributes to the development of migraines. In this case, smoking can make migraines more frequent, and it can make them worse.

The results of one study conducted in Spain illustrate the relationship between migraine and smoking well. In a sample of 361 medical students, 29% of migraine sufferers were smokers, whereas only 20% of non-migraine sufferers were smokers. Among the women, 22% of all women were smokers, whereas 34% of migraine sufferers were smokers. The researchers also found a correlation between the number of cigarettes smoked and the frequency of migraines; the participants who smoked more had more frequent migraines.

How Nicotine Triggers a Migraine

So we know smoking contributes to migraines, but how? It seems that nicotine, the same compound that makes smoking so addictive, is mostly to blame. Nicotine causes blood vessels to constrict. Constriction of blood vessels in certain parts of the brain, and in the meninges (the protective tissues that cover the brain), leads to altered brain activity associated with migraine symptoms. You probably won’t get a migraine every time you smoke, but consistently having nicotine in your system will make migraines more likely — and the more nicotine you take in, the worse off you’ll be.

Cigarette smoke also has a distinct odor. For some patients, the smell of cigarette smoke alone can be a migraine trigger. This means that non-smokers who live with or spend time with smokers may experience more serious and frequent migraines due to secondhand smoke. You don’t have in inhale enough to make you cough or to trigger a reaction to the nicotine; even the faint scent of smoke can set some people off.

Smoking May Worsen Cranial Autonomic Symptoms

We’ve touched on the idea that smoking can make migraine symptoms worse, so let’s dig into that a little more. Smoking seems to be associated with a specific subset of migraine symptoms called cranial autonomic symptoms, or CAS. These are symptoms associated with the cranial nerves, which stretch across the face, and specifically their autonomic functions — those are functions you don’t consciously control, such as sweating, inflammation, and blood vessel dilation.

CAS include:

• Sweating of the face and forehead

• Swelling of the eyelids

• Nasal congestion

• Tearing of the eyes

• Runny nose

In one study, 70% of migraine sufferers with a history of smoking suffered from CAS. Only 42% of non-smoking migraine sufferers suffered from CAS. So while it’s possible to suffer from CAS as a non-smoker, you’re more likely to develop these symptoms as a smoker.

Smoking, Migraine, and Stroke

The relationship between stroke and migraine has been well-studied, and the science makes it clear that migraine sufferers are at a higher risk for stroke than those without migraines. This is especially true in women who suffer from migraines with aura.

Smoking is also a major risk factor for stroke. Current smokers are between two and four times more likely to suffer a stroke compared to non-smokers and former smokers. If you are someone who suffers from migraines, your risk of stroke climbs higher if you also have additional risk factors for stroke — and being a smoker is a major one! Luckily, smoking is also a risk factor you have control over. Quit smoking, and you’ll reduce your risk of stroke, even as a patient who suffers from migraines.

Quitting and the Challenges of Withdrawal

To summarize what’s been discussed so far, smoking does not cause migraines — but often makes them worse, causes additional symptoms, increases their frequency, and puts you at an even higher risk of stroke as a migraine patient. Hopefully if you’re a migraine patient who smokes, the take-home message here is clear: you need to quit.

However, quitting smoking is never as easy as you’d hope, and it can be even more challenging for migraine sufferers than for the standard population. That’s because of a little thing called withdrawal. When you use nicotine, it binds to certain receptors in your brain, causing the release of dopamine. When you stop using nicotine, your levels of dopamine drop, causing a range of withdrawal symptoms including:

• Frustration

• Anxiety

• Mood swings

• Headaches (not necessarily migraines)

• Sleeplessness

If you looked at that list and thought “those sound like migraine triggers” that’s because some of them are. Anxiety, stress, and sleeplessness, especially, can trigger migraines, which unfortunately means that when you’re withdrawing from nicotine, you might actually suffer more migraines initially. However, it’s worth pushing through. Withdrawal symptoms diminish greatly after a week or two, and then you can enjoy all of the benefits of no longer smoking — including fewer migraines and headaches, plus a lower risk of stroke.

Quitting smoking is not easy, especially when you’re a migraine sufferer, but it is the best choice for your health in the long run. This is one reason why it’s so important to be working with a doctor who specializes in the treatment of migraines. If you can get your migraines under control with a combination of the right medications and some other lifestyle changes, then quitting will be easier.

Smoking and migraines do not mix, especially when you consider the relationship between smoking, stroke, and migraines. If you’re a migraine sufferer who smokes and is looking for a way forward, please contact me, Dr. Risa Ravitz. I specialize in treating migraines, and via an online consultation, we can find a combination of treatments that works well for you and your lifestyle.

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