Caffeine and Migraine

Caffeine is a chemical found naturally in food. It can also be made in a lab. It has a bitter taste, but we usually do not taste it or smell it since it is masked by other flavors. Over centuries, people have learned that caffeine can help relieve head pain. But it may also trigger headaches in some people.

Some people with migraine find a strong cup of coffee helps stop their attacks or reduces head pain. That is also why caffeine is added to some migraine drugs. However, caffeine does not work the same way in all people with migraine.^1-4

How does caffeine work on migraine pain?

Caffeine affects a brain chemical called adenosine. Adenosine is found naturally in human cells. During a migraine attack, adenosine levels go up. This causes brain blood vessels to widen, reduce electrical activity, and change other body functions. Caffeine can block some of these actions, reducing head pain.¹

Many studies have tried to reveal the secrets of how caffeine affects migraine attacks. One small study found caffeine worked better than a placebo (fake pill) and as well as acetaminophen for tension headaches.¹

Foods that have caffeine

Caffeine is found in many foods and drinks, but the amount of caffeine per serving can vary greatly. Some common examples include:²

• Regular coffee (5 oz): 30 to 164 mg, depending on how it is made
• Decaffeinated coffee (5 oz): 2 to 5 mg
• Tea (5 oz): 8 to 110 mg, depending on how it is made and what type of tea it is
• Chocolate: 9 to 18 mg depending on brand and amount
• Hot cocoa (6 oz): 2 to 8 mg
• Soft drinks (12 oz): 36 to 57 mg depending on the brand
• Energy drinks (8 to 20 oz): 47 to 500 mg

Migraine medicines with caffeine

Many prescription and over-the-counter drugs that treat migraine have caffeine, such as:^1,2

• Anacin: caffeine and aspirin
• Excedrin Migraine: caffeine, aspirin, and acetaminophen
• Midol: caffeine, acetaminophen, and pyrilamine maleate
• Norgesic: caffeine, aspirin, and orphenadrine citrate
• Fioricet: caffeine, acetaminophen, and butalbital

Many studies have found caffeine brings migraine relief when used alone and when mixed with other migraine drugs. One study found 1,000 mg acetaminophen plus 130 mg caffeine worked as well as sumatriptan (Imitrex) 50 mg to treat acute migraine. Both had similar side effects, which were mild or moderate. Doctors believe this means acetaminophen with caffeine may be a good option for people who cannot take triptans.³

Some over-the-counter cold medicines and diuretics also contain caffeine. Diuretics are drugs that cause your body to release more water and salt.²

The downside of caffeine

Yes, caffeine helps many people during a migraine attack. However, studies show that up to 1 in 3 people find caffeine actually triggers migraine symptoms. These same studies suggest that some people with migraine should avoid caffeine completely. Others should consume no more than 200 mg a day. Some people are more sensitive and their bodies react with a headache or migraine with as little as 10 mg of caffeine a day.^1,4

What seems to be the difference in how people respond to caffeine? People who consume caffeine daily or near-daily may develop a tolerance for the drug. This means that it takes more caffeine to get the same effect. Then the body comes to expect caffeine and revolts if it does not get it. This may trigger head pain, fatigue, trouble concentrating, and nausea.¹

Doctors believe a “rebound headache” is caused when the blood vessels open up without caffeine to keep the vessels narrow. Also, long-term caffeine use may change how adenosine acts in the brain.¹

This is why some doctors recommend that people with severe or chronic migraines avoid caffeine completely. This includes caffeine found in food, drink, and medicine. However, anyone who is consuming caffeine regularly and in higher amounts should not stop cold turkey. It is important to slowly decrease caffeine consumed to avoid a migraine or rebound headache.¹

It is important to talk with your doctor about how much caffeine you consume as you work to manage your migraines.