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Peer-reviewedCC BY 4.0Biological Trace Element Research

The Interrelationship between Cadmium, Smoking, and Migraine in the ELSA-Brasil Study

  • Arão Belitardo de Oliveira1,2
  • Fernando Barbosa3
  • Andrea Carmine Belin4
  • Joseph O. Lloyd4
  • Itamar S. Santos1,5
  • Mario Fernando Prieto Peres6,7
  • Paulo A. Lotufo1,5
  • Isabela M. Benseñor1,5
  • Alessandra C. Goulart1,2
7 affiliations
  1. 1Center for Clinical and Epidemiological Research, Hospital Universitario, Universidade de Sao Paulo, São Paulo, Brazil
  2. 2School of Public Health, Department of Epidemiology, University of Sao Paulo, São Paulo, Brazil
  3. 3Laboratório de Toxicologia Analítica e de Sistemas (ASTOx). Departamento de Análises Clínicas, Toxicológicas e Bromatológicas, Faculdade de Ciências Farmacêuticas de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, Brazil
  4. 4Centre for Cluster Headache, Department of Neuroscience, Karolinska Institutet, Stockholm, Sweden
  5. 5Department of Internal Medicine, School of Medicine, Universidade de Sao Paulo, São Paulo, Brazil
  6. 6Instituto do Cérebro, Hospital Israelita Albert Einstein, São Paulo, Brazil
  7. 7Instituto de Psiquiatria, Hospital das Clínicas, Universidade de São Paulo, São Paulo, Brazil
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Abstract

This study explored the relationship between serum cadmium (Cd), smoking exposure, and migraine in the ELSA-Brasil cohort (2008–2010). The analysis included 2,750 participants whose serum Cd levels were measured using inductively coupled plasma mass spectrometry. Smoking exposure was assessed using self-report data of active smoking and second-hand smoke. Migraine, including definite and probable migraine, was diagnosed according to the International Classification of Headache Disorders, 3rd edition (ICHD-3). Logistic regression was used to estimate the odds of migraine across serum Cd quintiles, using the third quintile as the reference category, while linear regression examined the relationship between smoking exposure and Cd levels. Polynomial contrasts tested linear trends. Participants had a mean (SD) age of 53.2 (9.0) years and 53.1% were women. Migraine prevalence was 29.1% (including probable migraine). Individuals with migraine had slightly higher median serum Cd levels than controls [0.050 µg/L (IQR 0.035–0.077) vs. 0.048 µg/L (0.035–0.066); p = 0.021], although smoking exposure scores did not differ between groups. Smoking exposure showed a strong positive association with serum Cd concentrations (p-trend < 0.001). Participants in the highest Cd quintile had greater odds of migraine [aOR 1.51 (95% CI 1.09–2.08), p = 0.011] after adjustment for smoking exposure and sociodemographic and clinical confounders. Sex-stratified analysis yielded even stronger associations among males [aOR 1.84 (95% CI 1.07–3.16), p = 0.027]. However, in the sensitivity analysis including definite migraine cases only, this association was no longer significant [aOR: 1.14 (0.71, 1.83), p = 0.579]. Main findings suggest that Cd exposure from smoking may contribute to migraine occurrence, particularly in males. However, other sources of Cd that could influence migraine should not be disregarded, and future investigation in this field is warranted.

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Cite

BibTeXRIS
BibTeX
@article{oliveira2026interrelationship,
  title = {{The Interrelationship between Cadmium, Smoking, and Migraine in the ELSA-Brasil Study}},
  author = {Arão Belitardo de Oliveira and Fernando Barbosa and Andrea Carmine Belin and Joseph O. Lloyd and Itamar S. Santos and Mario Fernando Prieto Peres and Paulo A. Lotufo and Isabela M. Benseñor and Alessandra C. Goulart},
  journal = {Biological Trace Element Research},
  year = {2026},
  month = sep,
  doi = {10.1007/s12011-026-05308-x},
  url = {https://doi.org/10.1007/s12011-026-05308-x},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - The Interrelationship between Cadmium, Smoking, and Migraine in the ELSA-Brasil Study
AU  - Arão Belitardo de Oliveira
AU  - Fernando Barbosa
AU  - Andrea Carmine Belin
AU  - Joseph O. Lloyd
AU  - Itamar S. Santos
AU  - Mario Fernando Prieto Peres
AU  - Paulo A. Lotufo
AU  - Isabela M. Benseñor
AU  - Alessandra C. Goulart
PY  - 2026
DA  - 2026/09/01
JO  - Biological Trace Element Research
DO  - 10.1007/s12011-026-05308-x
UR  - https://doi.org/10.1007/s12011-026-05308-x
AB  - This study explored the relationship between serum cadmium (Cd), smoking exposure, and migraine in the ELSA-Brasil cohort (2008–2010). The analysis included 2,750 participants whose serum Cd levels were measured using inductively coupled plasma mass spectrometry. Smoking exposure was assessed using self-report data of active smoking and second-hand smoke. Migraine, including definite and probable migraine, was diagnosed according to the International Classification of Headache Disorders, 3rd edition (ICHD-3). Logistic regression was used to estimate the odds of migraine across serum Cd quintiles, using the third quintile as the reference category, while linear regression examined the relationship between smoking exposure and Cd levels. Polynomial contrasts tested linear trends. Participants had a mean (SD) age of 53.2 (9.0) years and 53.1% were women. Migraine prevalence was 29.1% (including probable migraine). Individuals with migraine had slightly higher median serum Cd levels than controls [0.050 µg/L (IQR 0.035–0.077) vs. 0.048 µg/L (0.035–0.066); p = 0.021], although smoking exposure scores did not differ between groups. Smoking exposure showed a strong positive association with serum Cd concentrations (p-trend < 0.001). Participants in the highest Cd quintile had greater odds of migraine [aOR 1.51 (95% CI 1.09–2.08), p = 0.011] after adjustment for smoking exposure and sociodemographic and clinical confounders. Sex-stratified analysis yielded even stronger associations among males [aOR 1.84 (95% CI 1.07–3.16), p = 0.027]. However, in the sensitivity analysis including definite migraine cases only, this association was no longer significant [aOR: 1.14 (0.71, 1.83), p = 0.579]. Main findings suggest that Cd exposure from smoking may contribute to migraine occurrence, particularly in males. However, other sources of Cd that could influence migraine should not be disregarded, and future investigation in this field is warranted.
SN  - 0163-4984
SN  - 1559-0720
ER  -