Another factor is caffeine withdrawal. Additionally, studies have shown that ingesting too much caffeine is a risk factor for chronic migraine , which is a headache that can last for multiple days every month.
When it comes to the mechanisms of how too much caffeine actually triggers migraine attacks, researchers think there are two main ways an overabundance can create negative physiological effects:.
So while a small amount of caffeine in headache medication or in your coffee cup may be tolerable, going above and beyond that small amount could possibly trigger an attack. This could be via caffeine withdrawal, magnesium malabsorption, or dehydration. If you currently deal with migraine episodes and know that caffeine is a personal trigger, the answer is simple: Stay away from it whenever possible!
Try to keep the amount of caffeine you consume as consistent as possible. Suddenly increasing your intake could trigger a headache, and suddenly stopping your intake may result in caffeine withdrawal, which may also induce a headache.
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Caffeine withdrawal can affect anyone who regularly consumes caffeine. Two studies evaluated the efficacy of analgesics and caffeine in study populations that included patients with TTH and migraine [ 33 , ]. In the first, Diener et al. Pain intensity was recorded on a mm visual analogue scale. Additional efficacy results comparing AAC with the analgesic combination without caffeine and its constituents are shown in Table 4 [ 33 ]. It was concluded that AAC significantly outperformed all the other treatments for reductions in pain intensity, and that the clinically meaningful improvements compared with APAP or ASA monotherapy confirmed the existence of an adjuvant effect of caffeine in migraineurs.
Diener et al. Results of a 6-arm factorials study of the acute treatment of migraine and TTH a [ 33 ]. AEs were usually mild or moderate, and no subject in any study withdrew as a result of an AE that was considered to be related to active treatment. Across all studies and patient types, the most commonly reported treatment-emergent AEs were nervousness 6.
In patients with a range of pain conditions, Laska et al. Migliardi et al. Zhang found an effect of 1. A Cochrane review of caffeine adjuvancy in various pain states reported that the number needed to treat NNT for an additional patient to have relief of headache pain was 14 while the NNTs for postoperative dental pain, postoperative pain, and dysmenorrhea pain were 13, 16, and 25, respectively.
Considered by dose, 65 mg or less had no adjuvant effect in postoperative pain, while the NNT for doses of 70— mg was 14, and for doses above mg, the NNT was This review provides evidence for the role of caffeine as an analgesic adjuvant in the acute treatment of primary headache with OTC drugs.
The incidence of treatment-emergent AEs in these studies was low, and the type and severity of AEs was similar across headache diagnoses. These AEs, none of which were severe or unexpected, suggest that most patients who use caffeine-containing OTC combinations for occasional, acute treatment of TTH or migraine will experience good tolerability with appropriate use.
The relationship between caffeine and headache is complex, paradoxical, and often misunderstood. Used to excess, caffeine-containing analgesics can place patients at risk of medication overuse headache MOH and the progressive development of chronic TTH or chronic migraine [ 1 ].
At the same time, results from an uncontrolled, clinic-based study suggest that discontinuing caffeine consumption can improve the efficacy of acute migraine treatment [ 83 ]. Caffeine also has intrinsic antinociceptive properties, which enable it to be used as a monotherapy for relief of hypnic headache.
However, large acute doses can precipitate headache, as can abrupt cessation after regular dietary consumption. On the other hand, if addition of caffeine improves efficacy, it may reduce the number of doses of acute medication need to successfully treat an attack of migraine. In addition, patients are often willing to use OTC products earlier in an attack of headache which likely improves outcome and may reduce need for further treatment.
The risk of MOH is one of frequency of use. Appropriate dosing of caffeine in patients with migraine or TTH remains uncertain. Laska et al. Further, if low doses of caffeine inhibit antinociception, dietary caffeine might interfere with analgesic efficacy [ 31 ].
Awareness of the role of caffeine in the management of patients with headache should facilitate optimal use and help to avoid or address MOH. In clinical practice, certain groups of patients may benefit, including those with a partial response to simple analgesics and migraineurs with prominent gastroparesis-related nausea. Caffeine is widely consumed around the world in both food and beverages, and it has a variety of important medical applications.
In patients with headache disorders, caffeine monotherapy may be useful in some forms of primary or secondary headache. Its principal role is as an adjuvant in fixed combinations with analgesic medications for acute treatment of TTH and migraine. As might be expected with OTC preparations, tolerability is good for the vast majority of patients, and AEs are predictable and almost universally mild and transient. Additional studies are needed to assess the relationship between caffeine dosing and clinical benefit in patients with TTH and migraine.
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All authors read and approved the final manuscript. Richard B. Reddys, Eli Lilly, Teva, Vedanta. Lipton owns stock in eNeura and Biohaven. Matthew S. Robbins has received honoraria for educational activities from the American Headache Society, American Academy of Neurology, Medlink, and Springer and has received book royalties from Wiley. He has participated as a site principal investigator for a clinical trial sponsored by eNeura, Inc. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
National Center for Biotechnology Information , U. Journal List J Headache Pain v. J Headache Pain. Published online Oct Author information Article notes Copyright and License information Disclaimer. Lipton, Email: ude. Corresponding author. Received Jun 15; Accepted Sep 8. This article has been cited by other articles in PMC. Abstract Caffeinated headache medications, either alone or in combination with other treatments, are widely used by patients with headache.
Caffeine background Sources and consumption Caffeine is the most widely consumed psychoactive agent in the world [Citation removed]. Table 1 Selected sources of dietary and medical caffeine [ 16 ]. Serving size oz. Open in a separate window. Chemistry and pharmacology Caffeine, the common name for 1,3,7-trimethylxanthine, is a purine alkaloid with the molecular formula C 8 H 10 N 4 O 2 , a molecular weight of Medical applications Among patients with headache conditions, caffeine is used as an analgesic adjuvant.
Safety In the United States, the Food and Drug Administration considers caffeine a substance generally recognized as safe GRAS when used in 1 cola-type beverages in accordance with good manufacturing practice and 2 stimulant drug products [ 69 — 71 ].
Potential for overuse Frequent use of analgesics is an important health problem [ 84 ], and medication overuse by patients with episodic headache conditions is associated with the development of chronic headache conditions [ 86 — 89 ]. Tolerance Tolerance to the effects of caffeine on blood pressure, heart rate, diuresis, adrenaline and noradrenaline plasma levels, renin activity, and sleep patterns generally occurs within a few days [ 22 ], and regular daily doses of — mg can lead to tolerance to its subjective, pressor, and neuroendocrine effects [ — ].
Table 3 Pooled results from 3 migraine trials: AAC versus placebo for migraine at 2 and 6 h postdose [ 73 ]. Efficacy in mixed populations TTH and migraine Two studies evaluated the efficacy of analgesics and caffeine in study populations that included patients with TTH and migraine [ 33 , ].
Table 4 Results of a 6-arm factorials study of the acute treatment of migraine and TTH a [ 33 ]. Discussion This review provides evidence for the role of caffeine as an analgesic adjuvant in the acute treatment of primary headache with OTC drugs. Conclusions Caffeine is widely consumed around the world in both food and beverages, and it has a variety of important medical applications. Notes Competing interests Richard B. References 1. Stovner L, et al. The global burden of headache: a documentation of headache prevalence and disability worldwide.
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The fixed combination of acetylsalicylic acid, paracetamol and caffeine is more effective than single substances and dual combination for the treatment of headache: a multicentre, randomized, double-blind, single-dose, placebo-controlled parallel group study. Ibuprofen plus caffeine in the treatment of tension-type headache.
Clin Pharmacol Ther. Basurto, O. Caffeine is a constituent of many over-the-counter pain relievers and also some prescription drugs , mostly those that are used for headache or are promoted for the use in headache. Now interestingly, we know from scientific studies that caffeine is in fact a pain reliever. It's not a very strong one, but it is a pain reliever. And when one adds caffeine to aspirin or acetaminophen, it has the potential for producing additive pain relief. And that's the reason that the caffeine was originally added to these compounds many years ago.
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