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Review
. 2025 Jun 4;26(1):133.
doi: 10.1186/s10194-025-02076-2.

Smoking in primary headaches - a systematic review and meta-analysis

Bartłomiej Błaszczyk  1 , Helena Martynowicz  2 , Jakub Przegrałek  3 , Piotr Niemiec  3 , Marcin Straburzyński  4 , Sławomir Budrewicz  3 , Marta Waliszewska-Prosół  3
Affiliations
Review

Smoking in primary headaches - a systematic review and meta-analysis

Bartłomiej Błaszczyk et al. J Headache Pain. .

Abstract

Background: Primary headaches mainly consist of headaches such as migraine, tension-type headache (TTH), and cluster headache (CH). There is contradictory data concerning the association between smoking cigarettes and headaches. The objective of this study was to evaluate the prevalence of an association between smoking and primary headaches.

Methods: A systematic review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. PubMed and Scopus were screened up until February 2025. Next, those studies with eligible criteria related to this topic were included in a meta-analysis. To assess risk of bias, the Joanna Briggs Institute tool (JBI) was used. The random effects model was used to estimate odds ratios (OR) and smoking prevalence.

Results: There were 2,713 records out of which 37 studies were included in the meta-analysis. 22 out of the 37 included studies had a low risk of bias. The prevalence of smoking in migraine was 20% (95% CI: 16–24) and in migraine with aura (MwA) 27% (95% CI%: 17–27). For TTH, the prevalence was 19% (95% CI: 7–34) and in CH, it was 65% (95% CI: 55–76). The overall smoking prevalence in primary headaches was 32% (95% CI: 8–62). Current smoking was associated with an increased risk of migraine (OR = 1.29, 95% CI: 1.02–1.62, p = 0.034) compared to the group without any headache. Meta-regression revealed that neither age, sex, nor year of publication influenced this result. Current smoking was associated with a decreased risk of TTH (OR = 0.78, 95% CI: 0.68–0.89, p < 0.001). No association was observed between current smoking and CH and MwA; additionally, no association was found between former smoking and migraine. Meta-regression could not be conducted for TTH and CH.

Conclusions: Current smoking was associated with an increased risk of migraine and a decreased risk of TTH. There was no association between current smoking and CH despite the fact that over half of CH patients smoked. The influence of electronic cigarettes commonly used these days is not yet explored in primary headaches, despite the wide-spread use of such cigarettes among the young population who are vulnerable to primary headache onset.

Supplementary Information: The online version contains supplementary material available at 10.1186/s10194-025-02076-2.

Keywords: Cigarette; Exposure; Factor; Lifestyle; Nicotine; Tobacco; Trigger; Vaporize.

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Conflict of interest statement

Declarations. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
PRISMA 2020 flow diagram
Fig. 2
Fig. 2
The prevalence of smoking in migraine
Fig. 3
Fig. 3
The prevalence of smoking in MwA
Fig. 4
Fig. 4
The prevalence of smoking in TTH
Fig. 5
Fig. 5
The prevalence of smoking in CH
Fig. 6
Fig. 6
The overall prevalence of smoking in primary headaches
Fig. 7
Fig. 7
The meta-analysis results of current smoking and migraine in comparison to control patients. Abbreviations: OR, odds ratio; CI, confidence interval
Fig. 8
Fig. 8
The bubble plots of meta-regression
Fig. 9
Fig. 9
The meta-analysis results of former smoking and migraine in comparison to control patients. Abbreviations: OR, odds ratio; CI, confidence interval
Fig. 10
Fig. 10
The meta-analysis results of current smoking and MwA in comparison to MwoA patients. Abbreviations: OR, odds ratio; CI, confidence interval
Fig. 11
Fig. 11
The meta-analysis results of current smoking and TTH in comparison to control patients. Abbreviations: OR, odds ratio; CI, confidence interval
Fig. 12
Fig. 12
The meta-analysis results of current smoking and CH in comparison to control patients. Abbreviations: OR, odds ratio; CI, confidence interval
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