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Introduction The Global Burden of Disease study estimates that tobacco smoking caused 7.7 million deaths globally in 2019 and that smoking is the leading risk factor for disability-adjusted life years among men.1 Smokeless tobacco use, such as chewing tobacco, snuff, or tobacco chewed with betel nut, are estimated to have caused an additional 349 000 deaths in 2017.2 As of 2020, almost one billion people worldwide were estimated to smoke tobacco and 336 million were estimated to use smokeless tobacco, predominantly living in low and middle income countries.3 Although the prevalence of tobacco use (both smoked and smokeless) in low and middle income countries has decreased over the past 20 years, the prevalence is projected to be more than 20% in middle income countries and 12% in low income countries in the coming years.3 The tobacco associated health consequences can pose a risk to the health systems of these countries because many of them are not well prepared to cope with the increased need for care of related diseases, such as cancers and cardiovascular diseases

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Using high wattage or restricted airflow can intensify nicotine delivery and heat, both of which may contribute to headaches