Headaches are a frequently reported complaint associated with hookah use. The waterpipe, also known as shisha, functions by heating flavored tobacco or herbal material using hot charcoal placed atop the bowl. This process generates smoke that is drawn through water and inhaled. The unpleasant throbbing sensation is a direct physiological response to several factors inherent in the practice, not an inevitable consequence.
The Primary Culprit: Carbon Monoxide Exposure
The most significant physiological cause of the “hookah headache” stems from the charcoal used to heat the shisha. Charcoal combustion is an incomplete burning process that releases large quantities of the odorless, colorless gas Carbon Monoxide (CO). This gas is inhaled along with the smoke, leading to a form of mild poisoning.
Once CO enters the bloodstream, it binds to hemoglobin—the oxygen-carrying protein in red blood cells—with an affinity over 200 times greater than oxygen. This forms carboxyhemoglobin, displacing oxygen and preventing its delivery to the body’s tissues. The resulting systemic hypoxia, or oxygen deprivation, is acutely felt by the brain, manifesting as a headache, dizziness, and lethargy.
The method of use exacerbates this exposure because a typical hookah session lasts much longer than smoking a single cigarette, often an hour or more. During this prolonged period, users inhale a significantly greater volume of smoke. This extended exposure can elevate the concentration of CO in the blood, making carbon monoxide intoxication the primary mechanism behind the immediate headache.
Nicotine’s Effect on Blood Vessels
Beyond the effects of charcoal, the nicotine content within the shisha contributes to vascular-related headaches. Traditional flavored tobacco contains significant amounts of nicotine, although some herbal shisha is advertised as nicotine-free. Nicotine acts as a potent stimulant, primarily affecting the circulatory system.
The chemical triggers vasoconstriction, which is the narrowing of blood vessels throughout the body, including those supplying the brain. This constriction temporarily reduces blood flow and the delivery of oxygen and nutrients to the brain tissue. This change in blood flow dynamics can directly trigger a headache.
Furthermore, the concentration of nicotine inhaled can be quite high, with some single sessions delivering a dose comparable to a pack of cigarettes. For regular users, a headache may also represent a mild form of withdrawal if the session is spaced far apart from their usual intake.
Contributing Factors: Dehydration and Breathing Technique
Two additional factors related to the physical act and environment of using a hookah can compound the effects of CO and nicotine.
Dehydration
Dehydration is a common cause of headaches. The hot, dry nature of the inhaled smoke, combined with the extended duration of a typical session, leads to increased fluid loss through the respiratory system. A single session often lasts 45 minutes to an hour, causing fluid imbalance. Many individuals also combine hookah use with dehydrating beverages, such as alcohol or caffeinated drinks. This fluid deficit can cause brain tissue to temporarily shrink, activating pain receptors and resulting in a dehydration headache.
Breathing Technique
The second factor relates to the deep, forced inhalation technique commonly employed by users to produce large smoke clouds. Taking long, deep draws and sometimes holding the smoke can temporarily disrupt the normal balance of gases in the bloodstream. This breathing mechanic can lead to a brief period of hyperventilation, altering the balance of oxygen and carbon dioxide. This imbalance can cause a constriction of blood vessels in the brain, contributing to dizziness and a headache.
Practical Steps to Prevent Headaches
Users can take several straightforward steps to mitigate the risk of experiencing a headache from hookah use. To address Carbon Monoxide exposure, always ensure the environment is very well-ventilated by opening windows or using exhaust fans. It is also helpful to use fewer pieces of charcoal and ensure they are fully glowing red before being placed on the bowl, as partially lit charcoal releases more CO.
To minimize the impact of nicotine and vascular constriction, users should consider shisha products verified to have low or zero nicotine content. Limiting the depth and frequency of puffs will reduce the acute chemical load on the body. Furthermore, avoiding use on an empty stomach helps maintain stable blood glucose levels, which reduces sensitivity to vasoconstriction.
Combating dehydration requires a proactive approach by drinking plenty of water before and continuously throughout the session. To avoid issues related to breathing technique, users should consciously take slower, shallower draws and avoid holding the smoke in their lungs. Limiting the overall session duration also reduces the cumulative exposure to chemical and physical stressors.