Is there a connection between smoking and migraines?

The correct answer is “maybe” to “probably”. There is currently no study data specifically addressing this issue.  Studies of smoking and chronic headaches in general (not all chronic headaches are migraines) are available, but their application to migraines is limited.

A study of smoking and patients with chronic cluster headaches yielded some telling results.  Smoking patients who decreased their smoking by less than a half of a pack daily reduced their headache frequency by an amazing 50%.  This study just asked patients to cut down n their smoking, not to eliminate it.  Imagine the results that might have been achieved if the smokers quit entirely!

In another study, 53% of migraine patients who eliminated smoking in conjunction with the elimination of personally identified food triggers experienced a complete cessation of migraines.  By contrast, only 13% of non-smoking patients who eliminated their food triggers became migraine-free.

Many migraineurs (people who suffer from migraine headaches) are sensitive to strong smells, like perfume, food odors, and, yes, tobacco smoke.  Others are specifically sensitive only to the scent of tobacco smoke.  Still others are allergic to cigarette, cigar, and pipe smoke.

All of these people report having smoking or secondhand smoke trigger a migraine.  Sometimes the smoke is the only trigger, sometimes it is part of a combination of triggers.  Experts and sufferers agree there must be a link between smoking and migraines, somewhere, waiting to be uncovered.
Many of the commonly known effects of smoking are particularly detrimental to those prone to headaches and head pain.  These side effects include elevated blood pressure, inflammation or irritation of the sinus cavities and nasal passages, and higher risk of stroke. Health officials all agree on one thing, smoking is contraindicated for everyone in every situation and migraine sufferers are no exception.

No one knows for sure what causes migraine headaches.  The most likely to answer to-date is that a serious of small irritations or reactions pile up until, finally, a migraine headache is triggered.  Migraine triggers are different for each individual, but many migraineurs claim that a particular food or combination of foods will push them over the edge into a headache.

Keep in mind that most science disagrees with migraineurs when it comes to food triggers.  There are no conclusive studies indicating a link between certain foods and migraine headaches, so all information is anecdotal.  The thing is there is a lot, tons in fact, of anecdotal evidence for the link.

While a migraine trigger food can be, quite literally, anything, some foods come up on the trigger list for enough people to merit discussion.

Cheese

Cheese is a major trigger for many migraineurs.  Particularly likely to cause an attack are hard or aged cheeses.  Soft cheeses like cream cheese and new cheeses seem to be fine and unlikely to cause problems.

Processed Meats

Nitrates are believed by many to be a major migraine trigger.  For most people, the most common source of nitrates is processed meat, items like hot dogs, sausage, bacon, processed lunchmeats, etc.

Condiments

Salad dressings are a trigger for many.  The reason is not known, but is probably tied to a combination of other triggers all coming together in one place.

Spices and Additives

Any spice can be a trigger.  Spices as triggers may be tied, at least partially, to scent sensitivity, since many spices have a pungent odor. Seasonings that seem to give migraineurs the most trouble include monosodium glutamate (MSG), common in Asian foods, artificial sweeteners, food dyes, and vinegar.

Migraineurs who suspect a food trigger should consider trying an elimination diet to pinpoint the trigger food(s).

Anyone who has ever had a migraine will say they do not just happen in the head. The headache is usually the worst and most painful part of a migraine, but there’s more.  Most migraineurs (people who suffer from migraines) will talk about photosensitivity (sensitivity to light), phonosensitivity (sensitivity to sound), scent sensitivity, gastric pain, cramping, and vomiting.

Sometimes the abdominal symptoms show up without the other typical migraine symptoms.  When they do, a patient is said to be experiencing an abdominal migraine.  An abdominal migraine is pain, usually varying from mild to medium, in the abdomen.  The pain is either along the midline or unspecified and is frequently accompanied by abdominal tenderness, cramp-like spasms, bloating, vomiting, and loss of appetite.

Since abdomen pain can be caused by a wide variety of conditions other causes need to be ruled out before a diagnosis can be made.  In a classic abdominal migraine, no gastric cause for the pain can be identified.  Migraineurs need to let their doctors know about their migraines when they experience unspecified abdominal pain so that the doctor knows abdominal migraine may be a possibility.

Abdominal migraines are most common in children.  Children who experience abdominal migraines frequently grow up to be migraineurs.  While abdominal migraine is not unheard of in adults, it is rare.  Like most other types of migraine, it is also more common in females than in males.

While the exact cause of abdominal migraines is unknown, it is highly likely to be related to serotonin deficiency.  Serotonin deficiency has been linked in several studies to migraines, and 90% of the body’s serotonin is produced in the gastric system.  Serotonin deficiency causes cascading waves of nerve reaction in the brain when triggering a migraine and a similar process may be in effect in the abdomen.

There are a number of commonly held beliefs about migraines that make it hard for sufferers to get proper diagnosis and treatment.

1) Migraines are not real (all in the head, an overreaction to a normal headache, etc.).

Not true.  Migraines are a biologic primary headache disorder.  Even migraine pain is not confined to the head, though that is generally where it is worst.

2) Migraines have a known cause.

Sadly, no.  There have been several interesting theories put forward in the last decade, but no single, definitive biological cause of migraines has been identified thus far.

3) All migraineurs have the same symptoms.

No, they don’t.  This is one of the things that makes migraines so hard to diagnose, particularly if a patient’s doctor is only familiar with the most common symptoms.

4) A doctor can tell if it’s a migraine or not.

Not always.  The wide spectrum of symptoms that can accompany migraine can make it difficult to diagnose, more so if the patient is not forthcoming with their doctor about all their symptoms.

5) Migraines are curable.

Again, no.  Once properly diagosed many migraineurs still have to devote a lot of time and energy to managing their condition through medications, natural and homeopathic remedies, and diet and lifestyle changes.  The various available coping methods work differently for each individual, so there is not even a single protocol of care.

6) Migraines are a woman’s headache.

Women migraineurs do outnumber the men 3 to 1, but there is no evidence the condition is sex-linked in any way.

7) Only adults get migraines.

Migraines have been diagnosed in adolescents, children, and even infants.

Every headache a migraineur is a migraine

Not true.  Migraine sufferers can have regular sinus, tension, or stress headaches just like anyone else.

The Classification Subcommittee of the International Headache Society (IHS) publishes and revises the “International Classification of Headache Disorders”, now in its second edition.  This book offers specific diagnostic criteria for diagnosing migraines and is currently used worldwide.

According to IHS, a common migraine headache, also known as a migraine without aura, is defined by the specific criteria found below.

Frequency

The patient must have at least five of these headaches.

Duration

The headache, excluding attendant symptoms or prodromes, must last a minimum of four hours, up to seventy-two hours.  Headaches that last over seventy-two hours generally require immediate medical attention in order to rule out other, more dangerous conditions.

Pain Descriptors

In order to be classed as a migraine a headache must include at least two of four different qualities of pain:

1) The pain is one-sided; the headache is primarily on one side of the head.
2) The pain is not constant; it throbs, pounds, or pulsates.
3) The pain must be of moderate or severe intensity, to the point where the sufferer is inhibited in daily activity, potentially to the point of being temporarily disabled.
4) The pain is increased, sometimes only slightly, by routine physical activity like bending over, climbing stairs, or moving quickly.

Side Effects

Headache pain must be accompanied at least one of four common side effects:

1) Nausea
2) Vomiting
3) Photophobia – sensitivity to light
4) Phonophobia – sensitivity to sound

Secondary Exclusions

Appropriate medical testing, such as a MRI or CAT scan, and/or a physician’s exam must be conducted to rule out other conditions that may have caused the headache.

These criteria have helped simplify the diagnosis of migraine for many.  However, because migraines are historically associated with extremely high levels of pain, people suffering from moderate migraine may not realize that is what they are experiencing.