TOPLINE:

Smoking is more common among patients with medication-overuse headache (MOH), and both nicotine and analgesic dependence are associated with a greater headache burden, psychological distress, and addiction-related traits, new research showed.

METHODOLOGY:

• Researchers conducted a multicenter cross-sectional study including 442 adult patients (median age, 34 years) with primary headache disorders (150 with MOH and 292 without) across four university hospitals in Egypt.
• Patients underwent structured interviews and completed validated questionnaires, including the six-item Headache Impact Test (HIT-6); Severity of Dependence Scale (SDS); 12-item Depression, Anxiety, and Stress Scales (DASS-12); and Substance Use Risk Profile Scale (SURPS).
• Smoking status was recorded for all participants. Current smokers completed the Fagerström Test for Nicotine Dependence (FTND).
• Primary outcomes included the frequency of smoking, the level of nicotine dependence in patients with and without MOH, and differences in the headache burden and psychological profiles between patients with and without MOH and smokers and nonsmokers.

TAKEAWAY:

• Patients with MOH reported significantly more monthly headache days (20 vs 7; P < .001), acute medication days (17.5 vs 5; P < .001), and higher HIT-6 total scores (65 vs 60; P < .001) than those without MOH.
• Smoking prevalence was greater among patients with MOH than in those without (30.7% vs 14.4%; P < .001), and FTND scores were higher in patients with MOH (6 vs 3; P < .001; smokers only).
• Among smokers with MOH, FTND total scores positively correlated with monthly headache days, acute medication days, HIT-6 total scores, DASS-12 total scores, and SURPS total scores (P < .001 for all). SDS total scores positively correlated with the duration of MOH (P = .025), acute medication days (P < .001), HIT-6 total scores (P < .001), DASS-12 total scores (P = .001), and SURPS total scores (P = .003).
• Smoking was independently associated with MOH (odds ratio, 3.10; P = .003) even after adjustment for headache type, monthly headache days, HIT-6 total scores, and DASS-12 total scores.

IN PRACTICE:

“These findings imply that smoking, psychological distress, addiction-related traits, and MOH are closely interrelated dimensions within a shared biopsychosocial vulnerability profile, rather than isolated factors,” the investigators of the study wrote.

“Clinically, this highlights the need for comprehensive management strategies that address psychological distress, personality risk factors, and smoking behavior to identify high-risk patients, optimize outcomes, and prevent relapses,” they added.

SOURCE:

The study was led by Mona Hussein, MD, Beni-Suef University, Beni Suef, Egypt. It was published online on June 2 in Cephalalgia.

LIMITATIONS:

The cross-sectional design limited the ability to determine cause-and-effect relationships. The study relied on self-reported data and did not assess lifetime smoking history or non-cigarette tobacco use. Residual confounding due to unmeasured psychosocial or lifestyle factors was also possible. Finally, no details, including age at initiation and total duration of smoking, were provided in the study.

DISCLOSURES:

The study did not receive any funding. Disclosure information for study investigators is available in the original article.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.