Caffeine Vs Migraines: Is It A Cause Or A Cure?

WRITTEN BY  KHADHEEJA HAISHA SHAREEF CLASS OF 2025

This blog is about caffeine consumption and it’s effects on migraine attacks.

INTRODUCTION

As people who live in this fast-paced life of the 21st century, we all are very familiar with our friend caffeine. Most of us use caffeinated drinks, either for late night studies, to get us started in the morning or just for the love of the drink. Whether its tea or coffee or energy drinks we all are somewhat reliant on caffeinated drinks. Most people who are reliant on caffeine will also know about migraines. Some will argue that they drink caffeinated drinks to relieve their migraines and others may argue that caffeine usually triggers it. This has become a long-standing argument not just among the general population but also among medical professionals and scientific researchers.

WHAT IS A MIGRAINE?

International Classification of Headache Disorders (ICHD), 3rd edition, defines migraine as a recurrent headache disorder that manifests as attacks which last between 4 to 72 hours. Typically, migraines are unilateral, throbbing and vary in intensity from moderate to severe. Migraines will usually manifest with nausea, photophobia and phonophobia and can be aggravated by routine physical activity. A chronic migraine is a headache that occurs on 15 or more days every month for more than 3 months with the pain having the typical features of migraine for 8 days of the month.

WHAT IS CAFFEINE AND HOW IS IT RELATED TO MIGRAINES?

Caffeine is one of the most commonly consumed psychoactive compounds around the world. It is a naturally occurring methylxanthine that can be found in wide variety of food and drinks, the most well-known being coffee, followed by teas, energy drinks and chocolates.

Caffeine affects our body through multiple mechanisms.

The main mechanism is by the inhibition of adenosine receptors in the central and peripheral nervous system.

The structure of caffeine is similar to adenosine and therefore, can attach to adenosine receptors mainly the receptors, A1 and A2A. The activation of A1 and A2A receptors leads to anti-nociceptive effect, and therefore, inhibition of these receptors by caffeine can lead to pain relief.

Studies have also shown that caffeine has inhibitory effect on leukotriene and prostaglandin synthesis which can also lead to pain relief. This mechanism of receptor antagonism together with the effect on the eicosanoid pathway could be the link to the pain relief as well as the possible trigger of migraines.

CAFFEINE AS A TRIGGER FOR MIGRAINES

Caffeine acts as a trigger for migraines by two main mechanisms; caffeine withdrawal and caffeine overuse.

A withdrawal headache as per ICHD-3 is defined as a headache experienced by people who frequently consume caffeine (>200mg/d for >2 weeks) and then stop intake. The headache usually develops within 24 hours of last caffeine intake and usually relieved within 1 hour of ingestion of caffeine (100mg) or resolves within 7 days. This withdrawal headache is considered to be caused due to the vasoconstrictor effect of caffeine which leads to increase in cerebral blood flow (CBF).

 Similar to caffeine withdrawal, overuse of caffeine especially caffeine containing medications is considered to cause migraines. Some possible reasons include:

 1. The diuretic effect of caffeine which leads to dehydration.

2. Decreased magnesium levels due to increased caffeine intake.

3. Adenosine A1 receptor antagonism which leads to increased nitrous oxide levels and the consequent vasodilation.

 4. A risk factor for migraine chronification (persistent headaches for >15 days/month for >3 months.

CAFFEINE AS A RELIEF OF MIGRAINES

There have been various debates on the possible effects of caffeine on the relief of headaches.

 There are various drugs for pain relief which contains caffeine including combined drugs with acetaminophen or aspirin. There are various suggested mechanisms for it and out of this which includes

: 1.The antagonism of adenosine A2A receptors, which leads to the decrease nitrous oxide and therefore increase cerebrovascular resistance (CVR) and decrease CBF.

2.Direct effect to increase in CBF production that can lead to negative feedback and vasoconstriction.

3.Gastric stasis is considered to be one of the main signs of migraines and can be presented as nausea. Caffeine is shown to have direct effect on the GIT with increased intestinal motility and reducing intestinal transit time. This helps to relive the nausea which occurs during migraines.

RECOMMENDATIONS FOR CAFFEINE LOVERS!

a) Keep a diary! Those who frequently have migraines should be aware of the amount of caffeine they consume per day and also should identify various products with caffeine they intake including coffee, tea, energy drinks, chocolates and caffeine containing meds.

b) If you are a regular caffeine consumer, try to keep a consistent intake of caffeine without sudden increase or decrease of the amount. If you are trying to reduce your daily intake, it is best to reduce by small amounts over weeks.

c) Try to keep your daily caffeine intake to 200mg/day (around two servings of caffeinated drinks).

d) Know your meds! Some frequently used medications such as paracetamol or aspirin could be in combination with caffeine. If you are using caffeine-containing analgesics try to limit consumption to two days every week to prevent medication overuse headache.

CONCLUSION

Caffeine can be both a trigger and a treatment for migraines, it all depends on your volume of intake and tolerance to caffeine. It is best to always remember that too much of something is never a good thing. The same can be said of caffeine, as used in moderation it is good for us and used too much can lead to a headache.