Caffeine is an addictive psychoactive drug that changes cerebral neurochemistry. Caffeine is commonly imbibed in large doses by migraineurs, persons with Migraine. Then often the person drinking all that coffee will suddenly stop. This leads to caffeine withdrawal which is not a pleasant experience. Migraine affects 12% of the American population.  25% of women and 6% of men have migraine which is inherited as a genetic/family medical problem.

Need some more information on just what Migraine is? Read my website article, www.doctormigraine.com. Please click here to read.

Americans are confused about how caffeine works.  They know that it helps mild migraine headaches when they occur, but do not know that taking too much caffeine can aggravate, or to use the proper medical term, cause “chronification of migraine.”

What’s the deal on caffeine and Migraine? Does getting off caffeine make you sick or give you headache?

Read my Mini Book on Migraine Here.

This is an article by Britt Talley Daniel MD, retired member of the American Academy of Neurology, Migraine textbook author, podcaster, YouTube video producer, and blogger.

As a general rule for someone drinking a lot of coffee and having frequent Migraine headaches, stopping Caffeine improves their headaches, but they may have to go through the withdrawal experience.  After this they need to limit how much coffee they drink.

Many migraine patients drink too much coffee every day, and over 400 mg of caffeine is bad for general health and may activate medication overuse headache. 

Never heard of medication overuse headache and need an update? Read my website article “Medication Overuse Headache” on my website, www.doctormigraine.com. Please click here to read.

Migraine patients may also take caffeine type painkillers like Excedrin, BC Powder, and Vivactin for headache relief, sometimes several days a week, in addition to their daily regular caffeine use.

When I see a new patient, I do a caffeine count during the interview.

Related comments.

Caffeine will treat mild Migraine headaches.

This is certainly true and many persons treat their “sick, menstrual, one-sided, throbbing, sinus” headaches with caffeine products, like Excedrin. Many of them do not even know they have Migraine, but only the simple lay term in quotes above.

Only a small percentage of the Migraine population even see a doctor and get on effective acute or preventive Migraine therapy.

Migraine pathophysiology cause the cerebral arteries to dilate and caffeine is a vasoconstrictor

Caffeine overuse.  A Starbucks habit can aggravate migraine occurrence as all Starbucks coffees have high caffeine levels.  A Starbucks coffee Grande has 550 mg of caffeine.

A total caffeine intake dietary history should be taken by the doctor.

Medication overuse headache is commonly aggravated by caffeine use.

The Diagnostic and Statistical Manual V (DSM5) has stated that caffeine is an addictive drug at a level of 120 mg per day.

How does Caffeine promote increased headaches

The migraine process first causes inflammation of the trigeminal nerve which carries pain from the thalamus, a nucleus in the center of the brain, to the face and the head.  Twenty to forty minutes later the ganglia of the trigeminal nerve and the cerebral arteries start releasing the inflammatory neurochemicals:  Neurokinin A, Substance P, and CGRP in the brain which cause cerebral arterial vasodilatation and inflammation of the trigeminal nerve, the arteries and the thalamus.  See the picture of the migraine treating cycle below.

These neurochemicals remain in the body for 4-72 hours, are metabolized in the liver, and then removed from the body to the toilet.

An episode of migraine is defined as lasting 4-72 days.  However, in some migraine patients, on the second or third day of their migraine if they take caffeine, NSAIDs, opioid narcotics, or butalbital, they then get 3 more days of the inflammatory neurochemicals, and the migraine headache continues.

If the patient continues overtreating with pain killers , the headache becomes chronic and more intense.

It is like someone pouring gasoline on a wood fire which just keeps burning as long as there is wood and kerosene.  Caffeine represent kerosene in this example. Daily headache develops and the patient then develops chronic migraine which is defined as at least 15 headache days a month, 8 of which have migraine features.

Caffeine taken daily in this situation is one of the most common drugs which causes chronic migraine.  Thus, caffeine taken at low dose and 2 days a week only, may treat mild migraine headaches, but at higher doses, it worsens the situation for certain persons and causes medication overuse headache.

Hey, read my article on this, “The Migraine Timing Cycle” on my website, www.doctormigraine.com. Please click here to read.

Article on how stopping caffeine improves Migraine.

Lee, M.J., et al wrote in J Headache Pain  2016 Dec;17(1):71 on Caffeine discontinuation improves acute migraine treatment: a prospective clinic-based study

Abstract

Background: Caffeine has both excitatory and vasoconstrictive effects on the central nervous system.  Caffeine use might be associated with development and chronification of migraine.  We aimed to evaluate the effect of caffeine cessation on the acute treatment of migraine.

Methods: We prospectively recruited migraine patients who consumed caffeine drinks daily and instructed them to discontinue their caffeine intake.

Triptans were prescribed for acute treatment.  Patients were followed up after at least two weeks after screening and evaluated the efficacy of acute treatment with the migraine assessment of current therapy (Migraine-ACT) questionnaire.

Excellent efficacy was defined as Migraine-ACT score of 4. Chronic migraine, body mass index, allodynia, depression, anxiety, antiemetic use, and use of prophylactic medication were included in the multivariate analysis if the univariate p < 0.2.

Findings: Among 108 patients included, 36 completely discontinued their caffeine intake (abstinence group).  The efficacy of acute treatment was assessed at median 34.5 days (interquartile range, 28-89) after the screening.  Twenty-six patients (72.2 %) in the abstinence group and 29 (40.3 %) in the non-abstinence group reported an excellent efficacy (p = 0.002). The abstinence group also showed a trend toward greater reduction of headache impact test-6 (HIT-6) scores (p = 0.085).  Caffeine abstinence was independently associated with an excellent efficacy of acute treatment (multivariate odds ratio, 3.2; 95 % confidence interval, 1.2-8.4; p = 0.018) after controlling for covariates.

Conclusions: Caffeine abstinence is associated with better efficacy of acute migraine treatment. Our uncontrolled study results encourage a further confirmatory study on this issue.

Caffeine, the most popular psychostimulant drug in the world, may act as a double-edged sword in migraine patients.

Check out my Big Book on Migraine Here.



Articles about caffeine and headache

Just reading the titles of the articles listed below instructs the reader of the problem with caffeine aggravating migraine and that this problem has been studied for a long time.

Hering-Hanit R, Gadoth N (2003) Caffeine-induced headache in children and adolescents. Cephalalgia Int J Headache 23(5):332–335.

Scher AI, Stewart WF, Lipton RB (2004) Caffeine as a risk factor for chronic daily headache: a population-based study. Neurology 63(11):2022–2027.

Hagen K, Thoresen K, Stovner LJ, Zwart JA (2009) High dietary caffeine consumption is associated with a modest increase in headache prevalence: results from the Head-HUNT Study. J Headache Pain 10(3):153–159. doi:10.1007/s10194-009-0114-6.

Shapiro RE (2007) Caffeine and headaches. Neurol Sci Off J Italian Neurol Soc Italian Soc Clin Neurophysiol 28(Suppl 2):S179–S183.

Silverman K, Evans SM, Strain EC, Griffiths RR (1992) Withdrawal syndrome after the double-blind cessation of  caffeine consumption. N Engl J Med 327(16):1109–1114.

Summary:

Caffeine is often the hidden problem for headache doctors trying to take care of their Migraine patients. Most persons will tell me—Sure, I’ll stop my hydrocodone and tramadol, but “I can’t stop my coffee!”

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All the best.

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Britt Talley Daniel MD