Caffeine: a blessing and a curse
Coffee is everywhere in our society, with Starbucks and Tim Hortons at every corner. Drinking coffee is part of our social events and routines. Caffeine is a central nervous system stimulant that plays a dual role in migraine, being both beneficial and harmful.
Caffeine is overall favorable for brain health
A regular intake of coffee has been associated with decrease risk of stroke, dementia and Parkinson’s disease. It does increase alertness and can improve mood. A daily dose of 400 mg is judged safe. It is recommended to stop during pregnancy or limit to 300 mg per day.
Caffeine can be bad for migraine
- Regular intake of caffeine may increase the frequency of migraine: People with migraine, tension-type, and other headaches who use caffeine are more likely than non-users to suffer a worsening of their headaches called chronification (See this post). This is the process in which headaches progress from infrequent, to frequent, to very often or daily headaches. Caffeine may then lead to a caffeine-overuse-headache.
- Caffeine is not good for quality sleep:Caffeine also impairs sleep. The half-life of caffeine is 5-6 hours. This means that half of the caffeine you consume is still stimulating your nervous system 5-6 hours after you drink it. It can take up to a full day to completely eliminate caffeine from your body. Some people process caffeine slowly and other very fast. This simulation from caffeine prevents people from falling asleep and impairs sleep quality. Poor sleep is a trigger for migraine attacks(See this post).
- Stopping caffeine may trigger attacks:people with migraine who drink caffeine regularly may become prone to attacks if they stop or even decrease their intake. It is a bit like a «coffee rebound headache».
- Some people even report caffeine as a migraine trigger: a recent study has shown an association between caffeine and migraine attacks, but of course this could happen because people use caffeine as a treatment or because they are more tired, and fatigue is the real trigger.
Caffeine can help to treat an attack
- If you are suffering a migraine attack, caffeine can be used effectively as an acute treatment, to help abort an attack. Caffeine boosts the effect of other analgesics (like acetaminophen and aspirin) and that’s why it is often used in a combined form. Since it is accepted during pregnancy, it can be an option during this time where many medications can’t be used (See this post).
How will I know how much caffeine I am consuming?
You probably drink more than you think. Caffeine can be found in coffee, black, white, and green tea, energy drinks, soft drinks, chocolate, and over the counter supplements and medications. Caffeine intake is frequently underestimated in teens.
The Health Canada website offers good tables on caffeine content. Please read the labels on products that you use. If you go to a coffee shop, ask for a website or printed information on the products you consume.
Starbucks equivalents can be found here.
Is it worth it stopping caffeine to improve migraine?
You should consider a caffeine cessation if:
- You have frequent or chronic migraine
- You notice that skipping coffee leads to rebound headaches
- Your sleep is difficult
- You have some anxiety
- You drink more than 200 mg of caffeine per day
- You drink mostly coffee and no water (some of us do that)
Like any other treatment approach. Use a headache diary, do it for real and see if there is a change in your migraine. Also observe sleep and anxiety levels.
Should I completely stop or can I only decrease?
There are two schools of thought – the first is that up to 200 mg of caffeine per day is safe for people with migraine. The other is that people with migraine will be better off over time if they eliminate caffeine completely. If you do choose to continue caffeine, consider making sure you are not having more than 200 mg per day.
According to a study, stopping completely was better than just decreasing (72% vs 40% good improvement in headache frequency).
How to Safely Reduce
Do not stop caffeine abruptly! This will result in a withdrawal headache. You should reduce slowly by cutting out the equivalent of ½ to 1 cup of coffee, tea, or soft drink. Stay at that level for a week and then reduce again. Continue this process weekly until you have met your goal or weaned off. If you do get a withdrawal headache, you can treat it with caffeine or with your usual acute treatment.
Caffeine is one important thing to evaluate for a person with migraine. Its effects on the brain are complex. Good luck with your trials!
1. Fried NT, Elliott MB, Oshinsky ML. The Role of Adenosine Signaling in Headache: A Review. Brain Sci. 2017;7(3).
2. Lee MJ, Choi HA, Choi H, Chung CS. Caffeine discontinuation improves acute migraine treatment: a prospective clinic-based study. J Headache Pain. 2016;17(1):71.
3. Lipton RB, Diener HC, Robbins MS, Garas SY, Patel K. Caffeine in the management of patients with headache. J Headache Pain. 2017;18(1):107.
4. Mostofsky E, Mittleman MA, Buettner C, Li W, Bertisch SM. Prospective Cohort Study of Caffeinated Beverage Intake as a Potential Trigger of Headaches among Migraineurs. The American journal of medicine. 2019;132(8):984-91.
5. Nehlig A. Effects of coffee/caffeine on brain health and disease: What should I tell my patients? Pract Neurol. 2016;16(2):89-95.
THE MIGRAINE TREE
- ACUTE TREATMENTS
- DEVICES AND NEUROMULATIOIN
- PREVENTIVE TREATMENTS
- PROCEDURES AND INJECTIONS
- SELF-CARE AND LIFESTYLE
- SOCIAL LIFE