Increased smartphone use was found to be associated with an increased requirement of acute medication and less relief from medication for primary headache, but not an increase in frequency or duration of headaches, according to research published in Neurology Clinical Practice.

Smartphone technology is advancing at a rapid rate, but excessive engagement with these devices is raising health concerns. In a cross-sectional study, researchers sought to determine whether smartphone use was associated with worsening of primary headache, including migraine, chronic migraine, and tension-type headaches.

The study was conducted between June 2017 and December 2018 in India, and included patients aged ≥14 years with primary headache. All patients underwent detailed neurologic examination and relevant investigations; information about headache pattern, severity, frequency, duration of episodes, character, location, and associated complaints were noted. Information was also obtained about new-onset headaches of >3 months.

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Each patient was required to answer questions regarding mobile phone use with respect to type of cell phone, daily usage duration, and type of usage. Questions were scored as 0 for “no” and 1 for “yes,” with the highest score of the questionnaire being 11. Patients were divided into non-smartphone users (NSUs; either did not use a cell phone or non-smartphone user) and smartphone users (SUs).

The primary objective was to determine the association between mobile phone usage and new-onset headache or increases severity of primary headache. Chronic migraine was defined as headache for >15 days a month for >3 months. Worsening headache was defined as 2-fold increase in severity and/or intensity. Secondary outcomes included the association of smartphone use in patients with primary headache who required medication, as well as the dosage, type of analgesic taken, pill count of acute medications per month, number of prophylactic drugs, duration of prophylactic drug use, and dosage.

A total of 400 patients were included in the study (194 NSU; 206 SU). Of the 194 NSU patients, 76 were not using any phone and 130 were using non-smartphones. NSU patients were older compared with SU patients. The majority of patients with headache were women (269/400); however, more men were in the SU group compared with the NSU group (39.3% vs 25.8%).

The most common headache type was migraine, followed by chronic migraine and chronic tension-type headache. More patients in the SU group reported more auras compared with the NSU group (17.5% vs 7.7%), but the course of headache was similar in both groups (worsened: NSUs, 71.6% vs SUs, 71.8%).

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Patients in the NSU group had similar duration of episodes compared with SU patients, as well as the number of episodes of headache per month (NSU, 7.3 vs SU, 7.1). Patients in the SU group took a higher number of pills for acute treatment with a median pill intake of 8 per month compared with 5 per month in the NSU group. A higher proportion of patients in the NSU group had relief with acute medications compared with the SU group, but the proportions of patients taking prophylactic medication and the median duration of prophylaxis were similar in both groups.

“Although the course of headache, frequency of episodes, and the pain scores were similar in NSUs and SUs, the SU group had higher frequency of medications for acute attacks with poor response to analgesics,” the authors concluded.


Uttarwar P, Vibha D, Prasad K, Srivastava AK, Pandit AK, Dwivedi SN. Smartphone use and primary headache: a cross-sectional hospital-based study Neurol Clin Pract. doi:10.1212/CPJ.0000000000000816