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Smoking and medication-overuse headache: Exploring the potential link between nicotine dependence and analgesic
Mona Hussein1, Amr Hassan2, Rehab Magdy2
1Department of Neurology, Beni-Suef University, Beni-Suef, Egypt.
Cephalalgia : an International Journal of Headache
|June 2, 2026
Summary
Smoking exacerbates medication-overuse headache (MOH). Higher nicotine dependence and psychological distress are linked to increased analgesic dependence severity in MOH patients, impacting headache burden.
Area of Science:
- Neurology
- Addiction Medicine
- Psychiatry
Background:
- Smoking is a known risk factor for medication-overuse headache (MOH), but underlying mechanisms require further investigation.
- Understanding the interplay between smoking, psychological factors, and MOH is crucial for effective treatment strategies.
Purpose of the Study:
- To explore the relationship between analgesic dependence severity, headache disability, nicotine dependence, psychological distress, and addiction-related personality traits in MOH patients.
- To elucidate the mechanisms linking smoking to medication-overuse headache.
Main Methods:
- A multicenter cross-sectional study involving 442 patients with primary headache disorders.
- Utilized structured interviews and validated questionnaires: HIT-6, SDS, DASS-12, SURPS, and FTND for smokers.
- Assessed smoking status, monthly headache days (MHD), and acute medication days (AMD).
Main Results:
- MOH patients (n=150) showed significantly higher MHD, AMD, HIT-6, DASS-12, and SURPS scores compared to non-MOH patients (n=292).
- Smoking prevalence and Fagerström Test for Nicotine Dependence (FTND) scores were significantly higher in MOH patients.
- Smokers exhibited increased MHD, AMD, MOH prevalence, DASS-12, and SURPS scores. FTND scores positively correlated with headache burden and psychological distress in smokers.
Conclusions:
- Analgesic dependence severity in MOH is strongly associated with headache burden, nicotine dependence, and psychological distress.
- Nicotine dependence and addiction-related personality traits are significant factors in MOH patients.
- These findings highlight the complex relationship between smoking, psychological factors, and medication-overuse headache.
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