Caffeine: Trigger or Treatment?
This is one article in a series the migraine contributors are working on called “Trigger or Treatment.” Migraine disease is a complicated illness, and one of the reasons is that we all react to things differently. It is easy to think of several items in conflict in migraine research or what we're told by various doctors, and the one I'm going to take on today is caffeine.
The coffee cycle
Some of the most severe headaches experienced by non-migraine or headache disorder sufferers are caffeine-withdrawal headaches. Someone who drinks several cups of coffee daily and runs out before they're able to make it to the store might wonder why they are suffering so much only to find it quickly relieved once a cup or two is procured.
However, caffeine is included in migraine combination medications, including Excedrin and Fioricet, and many of us have found that sodas with caffeine, or coffee, might help if used early in an oncoming migraine. I myself can't live without my Cherry Coke, and I take Excedrin “Tension Headache” formula which has caffeine and acetaminophen, and I usually find it helpful.
From the National Headache Foundation: "Caffeine can be a headache trigger or headache inhibitor. Before a headache or migraine, blood vessels tend to enlarge. Because it contains “vasoconstrictive” properties that cause the blood vessels to narrow and restrict blood flow, caffeine can aid in head pain relief. When caffeine is added to the combination of acetaminophen and aspirin, the pain relieving effect is increased by 40%."1
The average American consumes 200-300 mg of caffeine per day. Here is a list of some common caffeine-containing products and the mg of caffeine contained:
Drip coffee (5 oz) – 106-164 mg
Instant coffee – 47-68 mg
Decaffeinated coffee – still contains 2-5 mg
One shot of espresso (single latte, cappuccino) – 30-50mg
Loose black tea (5 oz) – 25 – 110 mg
Loose Green tea - 8-36 mg
Black tea bag, 1 minute – 20-80 mg (the longer brewed, the more caffeine)
Iced tea (12 oz) – 67-76 mg
Hot chocolate (6 oz) – 2-8 mg
Mountain Dew (12 oz) – 54 mg
Coca-Cola (all varieties) – 46 mg
Dr. Pepper – 41 mg
Pepsi – 38 mg
Diet Pepsi – 36 mg
Monster Energy (16 oz) – 160 mg
Red Bull (8.3 oz) – 76 mg
Hershey's chocolate bar – 9 mg
Hershey's Special Dark – 18 mg
NoDoz maximum strength – 200 mg
Excedrin Migraine or Extra Strength (2 tabs) – 130 mg
Understanding rebound related symptoms
While caffeine is not directly responsible for migraines, sudden withdrawal of it can cause a rebound effect, with which most of us are familiar. The NHF recommends those with frequent headaches (their wording) avoid daily use. For myself, I would avoid having multiple lattes or cups of coffee per day, but I seem to do fine with my usual intake of two 12 oz Cherry Cokes. So like everything, moderation is probably the best bet. If you have any questions about whether caffeine is hurting you, or could help you, ask your physician.
Can you tell when a migraine attack is coming?