Association Between Overall and Mentholated Cigarette Smoking With Headache in a Nationally Representative Sample

The objective of this study was to determine associations between cigarette smoking and the existence of headache in a nationally representative sample, with attention to differences in effect estimates between mentholated and non-mentholated cigarettes smoking.

We examined cross-sectional associations between cigarette smoking and headache in 8,399 adults who participated in the National Health and Nutrition Examination Survey (NHANES) 1999-2004. The existence of headache was determined by an affirmative response to the question "During the past 3 months, did you have severe headaches or migraines?" Further refinement of headache diagnosis was not possible. We used logistic regression models to examine the association between cigarette smoking and headache.

The current study included 8,399 participants aged 20 years and over, including 68% (n = 5491) never smokers and 32% (n = 2548) current smokers. Among the current smokers, 24% (n = 739) smoked menthol cigarettes, and 76% (n = 1719) smoked non-menthol cigarettes. Compared with never smokers, after adjustment for potential confounding factors, current smokers were more likely to have headache (OR: 1.38; 95% CI: 1.17-1.62; P < .001). With the increase of both the number of cigarettes smoked daily and pack-years of smoking, the likelihood of having headache was significantly increased compared with never smokers (P for linear trend < .001). Compared with non-mentholated smokers, mentholated smokers were not more likely to have headache (P = .302).

Based on a nationally representative sample, we found that cigarette smoking was associated with headache in an exposure-response manner. Mentholated cigarette smokers were not more likely to have headache compared to non-mentholated cigarette smokers.