If you are anything like me, you love a good cup of coffee in the morning. In fact, sometimes a cup of coffee in the afternoon sounds good too. The fact is, most Americans love their caffeine, and most studies have shown that caffeine in moderation does not show significant deleterious effects. However, when it comes to migraines, if a little is good, a lot is not better.
As a chronic migraine sufferer for more than 2 decades, and an avid coffee drinker for about the same amount of time, it took me a while to see that perhaps my love of coffee (and lets be honest, my love of all things caffeinated) could possibly be one of my migraine triggers.
It can be very difficult to sort out and identify triggers. Especially for people with very refractory and almost daily headache symptoms, it can be almost impossible to see any sort of pattern to migraines. And migraines may occur for a week straight, stop for a day or two and then resume, leaving the most astute sufferer wondering what could possibly be going on.
For me, I started realizing that even when my migraines were mostly controlled during the day, I would frequently awake with or be awoken from a deep sleep due to severe migraine symptoms. At first, it seemed like this was potentially just a typical time of day that I would experience migraines. After all, some data does show that many sufferers do have migraines in the early hours. But after some serious reflection and dietary evaluation, I had an aha moment that perhaps some of this was actually due to caffeine withdrawal. It seemed counterintuitive at first because if I was having a cup of coffee in the morning and the afternoon, how could I be withdrawing? I also noticed that when I was used to drinking 2-3 cups of coffee per day and then tried to abruptly cut down to 1 cup in the morning alone, this would also trigger early morning migraines. It was especially problematic if I had an occasional day that I was able to sleep in, because it seemed that my body was used to having caffeine by a certain time in the morning, and any deviance from this schedule was apt to cause severe early morning migraines.
The thing that makes it more difficult, is that caffeine can actually help treat acute migraines, likely due to the vasoconstrictive effect on blood vessels in the brain. Many people may notice that if they have a mild headache or migraine, a cup of coffee or soda may help. Additionally, many over the counter migraine treatments like Excedrin contain caffeine. However, this is definitely a time where moderation is key.
The fact is, caffeine is a drug. Like other drugs, when used in increasingly large quantities, it can become addictive to the body and cause problems. When used infrequently, like for acute headache, it can have helpful properties. But when used daily and in large quantities, it can lead to overuse headaches or “rebound” headaches as well as withdrawal headaches. Unfortunately, using more than 100mg of caffeine daily, which is the equivalent of an 8oz cup of coffee, is a known risk factor for daily headache. People with chronic daily migraine should restrict their caffeine use to this amount or less per day. People with episodic or occasional migraine, can probably get away with up to 200mg of caffeine per day. It is best to have a similar amount of caffeine and use at similar times in the day to avoid triggering migraine.
If you suspect that caffeine overuse may be a trigger for your daily migraines, consider cutting down very slowly. Do not be tempted to abruptly stop caffeine intake or you will likely suffer even more severe migraines. You should aim to decrease your caffeine intake by no more than approximately 25% per week. Try to keep your same caffeine schedule but decrease the amount or opt for a less caffeinated version of your typical coffee. And remember that caffeine is also in over the counter headache medicines such as Excedrin, and this needs to be included in your total daily caffeine intake as well.
As always, talk your medical doctor if you have any specific concerns.
Here’s to your health,
Dr. Camille
The Migraine Doctor