Coffee is one of the most popular sources of caffeine in the Western diet. Although it’s easy to become addicted to caffeine and stopping it abruptly causes withdrawal symptoms such as headaches, caffeine is generally considered safe for most people in reasonable amounts.
It is estimated that an intake of 400 milligrams (mg) per day is generally safe for healthy adults. For reference, an average 220ml cup of coffee contains around 80-100mg, and a 33cl cola-type soda around 30-40mg.
For people with migraines or headaches, the relationship between caffeine and their pain is tricky. On the one hand, caffeine can help relieve headaches but on the other hand, if you try to give up or reduce your caffeine intake, you may suffer from a temporary wave of headaches related to caffeine withdrawal.
Caffeine as a treatment for headaches
Caffeine appears to be an effective acute treatment for migraine, or at least part of acute migraine treatment from the patient’s perspective. Migraine patients often report that if they can consume a caffeinated beverage along with medication, it usually helps them during an attack. There are also over-the-counter and prescription headache and migraine medications that contain caffeine that may be helpful to some patients when they are having a migraine attack. Some over-the-counter formulations of the drug contain 65 mg of caffeine per tablet.
The mechanism of action underlying the painkilling potential of caffeine is related to blood vessels. Blood vessels dilate in migraine, and caffeine is considered beneficial because it causes vasoconstriction. This is what people think of when they consume a caffeinated drink or caffeinated medication while they have a migraine.
Caffeine headaches as a withdrawal symptom
Conversely, if you’ve ever tried to reduce your caffeine intake, you know that headaches can result. It doesn’t matter what foods or beverages the caffeine comes from, the problem is whether you are used to regularly consuming the same amount of caffeine each day. If you suddenly decrease your caffeine intake, you may get a headache. Caffeine withdrawal isn’t just for people who drink a lot of coffee or caffeinated beverages. It can also affect people who drink only a small cup of coffee a day. The incidence of headaches resulting from caffeine withdrawal can be as high as 50%, and this in the general population, not just in migraine sufferers.
Is your headache related to caffeine withdrawal?
If your headache occurs a few hours after your last caffeine intake or after missing your usual cup of coffee or energy drink, it may be a sign that it is related to a lack of caffeine. Typically, caffeine withdrawal headaches occur mid to late morning, as many people start their day with a coffee or something like that. Caffeine withdrawal headache can be different from a migraine. The headache has a mild to moderate profile, and it tends not to have the characteristics of a migraine.
Caffeine may contribute to medication overuse headaches
A certain type of headache is linked to overuse of medication, such as a headache occurring 15 or more days per month in a person with a pre-existing primary headache disorder, such as migraine, and developing as a result of overuse regular medication for acute or symptomatic headaches for more than three months. Several medications are linked to headaches, including combination pain relievers containing aspirin and caffeine.
However, caffeine-containing medications are not the only ones associated with this type of headache: a caffeine intake of 100 to 200 mg per day is probably enough to contribute to medication overuse headaches.
Caffeine as a risk factor for chronic migraine
There is evidence that excessive caffeine consumption is a risk factor for chronic migraine. We speak of chronic migraine when a person suffers 15 days or more per month from headaches with migraine characteristics. It is estimated that chronic migraine affects approximately 1-2% of the general population and nearly 8% of migraine sufferers. Each year, about 3% of people with episodic migraine “convert” to chronic migraine, according to a 2016 article published in the journal Nature Reviews Neurology.
Tracking headaches and caffeine intake can help
In people with chronic migraine or chronic headaches, it is best to track their headaches and try to gradually reduce their caffeine intake. That doesn’t mean you have to stop right away. This could put them in a severe headache situation. Instead, try cutting back on caffeine one or two days a week to see if that makes a difference. If the patient falls into the episodic migraine category (less than 15 days per month), caffeine intake and its relationship to migraine attacks should be monitored. Paying attention to whether caffeine seems to prevent or shorten an attack or whether it seems to trigger migraine can help determine whether reducing or eliminating caffeine is the best course of action.
Tips for reducing or eliminating caffeine
If you decide to reduce or stop caffeine, start slowly. If you like caffeine in the form of cold drinks such as sodas or energy drinks, try drinking water instead. Unsweetened caffeine-free iced tea can also be a satisfying substitute. If you’re a coffee drinker, try cutting out one cup of caffeine a day or drinking a mix of half-caffeinated and half-decaffeinated coffee. Slowly switching to a higher proportion of decaffeinated coffee over a period of several weeks can help you reduce your intake while minimizing withdrawal symptoms. But remember that decaffeinated coffee still contains a small amount of caffeine, which can make you addicted to caffeine and lead to withdrawal headaches if you suddenly stop decaffeinated.
Another idea to reduce caffeine intake: Exercise. Some people have been able to replace coffee with exercise, which seems to help them overcome the withdrawal process.
