Smartphone Use Connected to More Severe Headaches

Smartphone use in patients with primary headache is connected to more medication use and less pain relief, new research shows.

Investigators found 96% of patients with headache who used smartphones took pain relievers compared to 81% of their counterparts with headache who did not use smartphones.

Furthermore, smartphone users reported they received less pain relief from analgesics vs those who did not use smartphones — with 84% of smartphone users reporting moderate or complete relief of headache pain vs 94% of non-users.

"While these results need to be confirmed with larger and more rigorous studies, the findings are concerning, as smartphone use is growing rapidly and has been linked to a number of symptoms, with headache being the most common," study author Deepti Vibha, MD, DM, MSc, additional professor of neurology, All India Institute of Medical Sciences, New Delhi, said in a press release.

The study was published online March 4 in Neurology Clinical Practice.

Lack of Evidence

Smartphone technology is advancing at a rapid rate and excessive engagement with these devices is raising health concerns, the investigators note.

Previous research has demonstrated mobile phone use may be associated with an array of symptoms, including headache, but there is a "paucity of evidence on the association of primary headache and smartphone use," they add.

Vibha told Medscape Medical News that he was motivated to conduct the study based on previous research and the "observation and reporting by patients and their families of increased headache with mobile phone usage."

To determine the association between smartphone use and worsening of headache, the investigators identified 400 patients aged ≥ 14 years with primary headache, which includes migraine, tension headache, and other headache types.

Participants were divided into two groups — non-smartphone users (NSUs) and smartphone users (SUs).

SUs were further subdivided, with those who scored 0 to 1 on the smartphone addiction questionnaire defined as "low SUs," and those who scored ≥1 defined as "high SUs."

The study's primary objective was to investigate the association of mobile phone usage with new-onset headache, defined as a primary headache that became chronic or got significantly worse or increased severity of primary headache.

Of the 400 participants, 194 were NSUs and 206 were SUs. Most NSUs (n = 130) were using feature phones, while 76 were not using any phone.

NSUs were older than SUs (mean [SD], 35.2 [10.8] vs 30.7 [10.2] years, respectively).

Although the majority (67%) of patients with headache were female, there was a larger proportion of male patients in the SU group, compared with the NSU group (39.3% vs 25.8%, respectively; P = .004).

Preventive Strategies

NSUs tended to have lower socioeconomic status and lower education attainment, compared to the SUs.

Migraine was the most common headache type in both groups, followed by chronic migraine/chronic tension-type headache.

The duration of headache symptoms, headache course, and number of monthly headache episodes, were similar between NSUs and SUs, but there were notable differences in headache characteristics between the two groups.

Age at headache onset was older in NSUs, compared with SUs (mean [SD] age, 30.75 [10.6] vs 25.95 [8.9] years, respectively; P < .001). In addition, fewer NSUs than SUs reported aura (7.7% vs 17.5%, respectively; P = .003).

There were also differences between NSUs and SUs in patterns of analgesic use and the amount of relief patients obtained from medication. NSUs took a lower median number of pills for acute treatment, compared with SUs (5 pills/month vs 8 pills/month, respectively; P = < .001).

A lower proportion of NSUs were taking analgesics for acute attacks (80.0% vs 95.6%, respectively; P < .001) and a higher proportion of NSUs had complete relief with acute medication, compared to SUs (94.3% vs 84.3%, respectively; P ≤ .001).

High vs low SUs showed similar patterns. High SUs had higher monthly pill counts for acute treatment, compared with low SUs (10.0 vs 5.0, respectively; P = .007). A smaller proportion of high SUs vs low SUs reported complete relief with acute medication (42.3% vs 55.3%, respectively; P = .03).

"The use of [a] smartphone was associated with an increase in requirement of acute medication and less relief with acute medication," the investigators conclude.

However, Vibha noted that the study was not powered to establish a mechanism for the association, but rather they wanted to determine "if there was an association at all."

"Now that there is a direction, longitudinal studies may be able to look at putative and maybe unknown mechanisms," he said.

Ways of mitigating the deleterious effects of smartphones is by limiting their use and using the hands-free feature that doesn't affect neck position or cause strain during long conversations, Vibha added.

Impetus for an Upgrade

Commenting on the study for Medscape Medical News, Heidi Moawad, MD, clinical associate professor, Case Western Reserve University School of Medicine, Cleveland Ohio, who was not involved in the research, said she believes "clinicians already ask headache patients about habits like cellphone use," but this research "helps doctors and mobile device users have a sense of scale regarding the impact."

An accompanying editorial coauthored by Moawad, notes that the "root of the problem is not clear" and could be the user's neck position, the phone's lighting, eyestrain, or the stress of being connected at all times. There could also be "another characteristic that could lead to high cellphone use and have this same effect of more acute dosing and less effective medication."

Potentially helpful options might include features such as hands-free settings, voice activation, and audio functions that might "hold the key to helping smartphone users benefit from their phones without exacerbating their headaches," she stated in the editorial.

Moawad said she hopes these findings "will motivate innovation in the technology so our mobile devices will be upgraded in ways that won't cause issues like headaches, neck pain, eye strain, and more."

No source of study funding reported. Vibha, Moawad, and study and editorial coauthors report no relevant financial relationships.

Neurol Clin Pract. Published online March 4, 2020. Abstract, Editorial

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