A former migraineur believes eliminating caffeine from her diet five years ago has kept her headache free. She had been in the habit of having one cup of coffee in the morning that was made of half strength caffeine (half-caf), followed by a glass of iced tea at lunch, and sometimes chocolate in the evening. She weaned herself slowly off of all caffeine, experiencing withdrawal headaches as she continued to eliminate the caffeine. She is now 55 years old, and has been through menopause in the past three years. She wonders had this discovery occurred simultaneously with menopause, she might question which was responsible. However, since, the discovery preceded menopause, she feels certain that the cause was attributable to the caffeine. Edward Messina, MD at The Michigan Headache Clinic in East Lansing, Michigan weighs in on her situation…..
Caffeine has long been a controversial topic in the headache world. Due to the very large diversity of patient profiles and headache types, which we currently classify into about 200 categories, it is certainly conceivable that certain patients have an exquisite sensitivity to the drug, while others have no sensitivity whatsoever.
Many headache remedies incorporate caffeine and many patients report aborting headaches with an anti-inflammatory and a single cup of coffee. There are case reports of caffeine being useful in treating hypnic headaches as well as caffeine withdrawal headaches. On the other hand, caffeine is a common ingredient in the combination medications which cause medication overuse headaches. It is a question of the setting in which caffeine is used, or abused. In my experience, many patients have quit caffeine at my request and a few have noted no change. The only logical conclusion is that some people have a sensitivity to caffeine, but this is not a generalization which should dogmatically be applied to all migraine patients. It is certainly reasonable, however, for patients with refractory headaches to taper off caffeine gradually to see if they might benefit.
Remember, many people will use caffeine as a stimulant because of daytime sleepiness which might arise from under sleeping, insomnia, or sleep apnea, so another important question is to ask why people are using caffeine and seek the underlying cause, which might be the key to their headache problems.
www.headaches.org Volume 4, Issue 4 2015