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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\u00a0\u00b5g\/L (IQR 0.035\u20130.077) vs. 0.048\u00a0\u00b5g\/L (0.035\u20130.066);\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.021], although smoking exposure scores did not differ between groups. Smoking exposure showed a strong positive association with serum Cd concentrations (p-trend\u2009&lt;\u20090.001). Participants in the highest Cd quintile had greater odds of migraine [aOR 1.51 (95% CI 1.09\u20132.08),\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.011] 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\u20133.16),\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.027]. However, in the sensitivity analysis including definite migraine cases only, this association was no longer significant [aOR: 1.14 (0.71, 1.83),\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.579]. 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.\n                  <\/jats:p>","DOI":"10.1007\/s12011-026-05308-x","type":"journal-article","created":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T13:11:43Z","timestamp":1788268303000},"page":"8965-8975","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The Interrelationship between Cadmium, Smoking, and Migraine in the ELSA-Brasil Study"],"prefix":"10.1007","volume":"204","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6408-0634","authenticated-orcid":false,"given":"Ar\u00e3o Belitardo","family":"de Oliveira","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"suffix":"Jr","given":"Fernando","family":"Barbosa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea Carmine","family":"Belin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph O.","family":"Lloyd","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Itamar S.","family":"Santos","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mario Fernando Prieto","family":"Peres","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paulo A.","family":"Lotufo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isabela M.","family":"Bense\u00f1or","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessandra C.","family":"Goulart","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,9,1]]},"reference":[{"key":"5308_CR1","doi-asserted-by":"publisher","first-page":"P1005","DOI":"10.1016\/S1474-4422(25)00402-8","volume":"24","author":"GBD 2023 Headache Collaborators","year":"2025","unstructured":"GBD 2023 Headache Collaborators (2025) Global, regional, and national burden of headache disorders, 1990\u20132023: a systematic analysis for the Global Burden of Disease Study 2023. 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Additionally, he has received honoraria and consultation fees from Pfizer, Lundbeck, AbbVie, Teva, Sanofi, Libbs, and Lilly for advisory roles and expert consultations. Dr. Peres has also participated in company-sponsored speaker\u2019s bureaus for Pfizer, Lundbeck, AbbVie, Teva, Sanofi, Libbs, and Lilly, delivering educational presentations and lectures. The other authors declare there is no conflict of interest.","order":2,"name":"Ethics","label":"Competing Interests","group":{"name":"EthicsHeading","label":"Declarations"}}]}}