Conventional cigarettes, novel heated tobacco products, and self-reported frequent headache association in Japanese individuals: Insights from the JASTIS study, a Japanese cross-sectional analysis.

OBJECTIVES/

BACKGROUND

Heated tobacco products (HTPs) are novel alternatives to conventional cigarettes that heat tobacco leaves to generate nicotine-containing aerosols for inhalation. This study aimed to investigate the association between both conventional cigarette use and HTP use with self-reported frequent headache. Although the association between cigarette smoking and headache has been reported, evidence regarding HTPs remains limited.

METHODS

We utilized data from the Japan Society and New Tobacco Internet Survey, an ongoing internet-based cohort cross-sectional study launched in 2015 to monitor conventional cigarette and HTP use. Participants were recruited from a nationally representative online panel, comprising over 2 million individuals. Among 28,000 respondents in the 2025 wave, we included 23,228 individuals with valid responses. Self-reported frequent headache was defined as responding "occasionally" or "frequently" to the question, "Have you experienced headaches in the past year?" (other options: "never" and "rarely"). We conducted a multivariable analysis adjusting for demographic, socioeconomic, lifestyle, and clinical variables. We then compared the adjusted odds ratios (aORs) of conventional cigarettes and HTP use for the prevalence of self-reported frequent headache.

RESULTS

Of the 23,228 participants, 25.5% (5923/23,228) reported headaches. Regarding tobacco use, 12.2% (2823/23,228) were current cigarette users, 31.8% (7393/23,228) were former cigarette users, 56.0% (13,012/23,228) were never cigarette users; 11.6% (2688/23,228) were current HTP users, 10.0% (2326/23,228) were former HTP users, and 78.4% (18,214/23,228) were never HTP users. Multivariable analysis with multiple imputation revealed that current (aOR = 1.71 [95% confidence interval [CI] = 1.44-2.03]) and former (aOR = 1.54 [95% CI = 1.37-1.73]) cigarette use, and current (aOR = 1.15 [95% CI = 1.01-1.32]) HTP use were significantly associated with self-reported frequent headache. Former HTP use was not significantly associated with headache (aOR = 1.09 [95% CI = 0.96-1.24]). Postestimation comparisons indicated a weaker association for HTPs than for cigarettes (current smokers vs. current HTP users: ratio of aORs = 1.48 [95% CI = 1.19-1.84]).

CONCLUSION

Both current and former cigarette use were significantly associated with a higher prevalence of self-reported frequent headache, and current HTP use also showed a modest but significant association. Although HTPs are often perceived as less harmful, they still emit nicotine and other constituents, which may be associated with self-reported frequent headache.