Caffeine & Migraine: Friends or Foes

Have you ever been told to cut out caffeine for migraine?

But… many pain relievers have caffeine, and bring relief for migraine attacks. Sometimes even a cup of coffee can alleviate migraine pain and symptoms.

So what’s the deal? Is caffeine our friend or our foe?

In this article, we’ll dive into the pros and cons of caffeine for migraine, as well how discover your tolerance to caffeine.

Caffeine sources

Whether caffeine helps or hurts, it’s good to know where it is found.

  • Energy drinks
  • Soft drinks
  • Coffee (even in “decaffeinated”)
  • Black tea
  • Green tea
  • Matcha
  • Chocolate

It’s important to recognize that coffee and chocolate are frequently put into other foods, like ice cream or yogurt. Read ingredient labels for these “hidden” sources of caffeine.

Caffeine may also be in supplements or medications. Common sources include weight loss or alertness aids and pain relievers.

Caffeine effects

You may be familiar with the symptoms of caffeine (alertness, jitters, anxiety) but what does it actually do?

Caffeine is a central nervous system stimulant, meaning that it “speeds up” activity in your brain. There are two classes of “drugs” for the central nervous system, stimulants and depressants. We will go over the differences to give you more insight into how caffeine works.

I know it is weird to consider caffeine a drug, but more on this later!

Stimulants:

  • These speed up systems in the brain and body.
  • Stimulants release a neurotransmitter called dopamine, considered the “happy hormone”. This gives a “rush” and feeling of euphoria. This release of dopamine is associated with developing a dependency or addiction to stimulants.
  • They also release norepinephrine, which contributes to much of the “speeding up” of the brain and body. Norepinephrine is correlated with alertness, wakefulness, and focus. It also increases blood pressure, heart rate, breathing rate, blood sugar, and constricts blood vessels.
  • Stimulants may treat conditions such as ADHD or depression.

Caffeine has one additional role as a stimulant. It has a relationship with adenosine, which promotes sleepiness. Caffeine blocks adenosine, further helping you keep awake.

Depressants:

  • Depressants have an opposite effect, slowing activity.
  • They release gamma-aminobutyric acid (GABA) in the brain, which “slows down” brain activity. This brings on a feeling of calmness, sleepiness, and clumsiness.
  • Depressants may treat conditions such as anxiety or sleep disorders.

Pros

General health benefits to caffeine include:

  • Increased alertness and wakefulness
  • Good source of antioxidants, helping to prevent chronic diseases such as type 2 diabetes, heart disease, and some cancers

Caffeine plays a significant role in pain management, here are some actions that are beneficial to migraine:

  • Blood vessels:
    • Before a migraine attack, blood vessels widen. Caffeine combats this by narrowing blood vessels (through its release of norepinephrine). This effect is thought to help decrease migraine symptoms.
  • Dopamine:
    • The release of dopamine, considered a “happy hormone”, may be a natural pain-killer.
  • Adenosine:
    • While caffeine’s impact on adenosine receptors helps us to stay more alert, it may also reduce pain signaling or sensations.
    • Adenosine levels are higher during migraine attacks, so it is possible that blocking the release of adenosine through caffeine may also play a role in treating attacks.
  • Assist other painkillers:
    • Caffeine is believed to assist other pain relieving methods. This could be done through getting painkillers into the bloodstream more quickly, slowing the rate at which they are “cleared” from the bloodstream, or through the mood-boosting release of dopamine.

Cons

There are some general health risks to consuming caffeine, including:

  • Increased anxiety
  • Impaired ability to sleep
  • Heart palpitations – “missing a beat” or racing/pounding heartbeat
  • Increased blood pressure
  • Upset stomach
  • Dehydration

Caffeine consumed through energy drinks, soft drinks, chocolate, or coffee with added ingredients increase your “added sugar” intake. It is recommended to keep added sugars at 10% of your daily intake, which may be as little as 2 tablespoons per day.

There are three major concerns regarding caffeine and migraine:

  1. Withdrawal
    • Caffeine withdrawal is considered a clinical condition. There are uncomfortable symptoms including fatigue, irritability, depressed mood, and headaches or migraine attacks.
    • Weekend attacks” can be a small-scale version of caffeine withdrawal. Migraine brains love routine, so even a small delay in your daily caffeine intake can cause you harm.
  2. Excessive intake
    • While some caffeine could help an attack, having too much may actually trigger an attack.
    • Some people are more sensitive to caffeine than others. In fact, some may actually have a sensitivity to caffeine!
  3. Medication adaptation headache
    • This is a diagnosis for people with frequent attacks that have worsened when taking medication too often.
    • Guidelines for medication doses per month:
      • 10-15 days using over-the-counter painkillers
      • 8-10 days using triptans
      • 10 days using opioids/narcotics
    • Caffeine should be limited to 200mg per day, about 2 cups of coffee.
    • Frequent medication lowers your threshold, making it easier for an attack to start.
    • [Click here] for a full article on this topic!

My experience

I’ve had migraine since I was a child, and became a huge fan of caffeine as a teenager.

It started as a fun “foo foo” drink to bring into my first-period high school classroom, and quickly evolved to a plain cup of hot coffee that was a beloved daily routine.

In college, I started experiencing “weekend attacks”. My migraine overall was worsening too, so it was frequently suggested that I kick my caffeine habit. I hesitated because I already knew how helpful caffeine is for me… I have strong memories of chugging coffee or Coke to get through some work shifts on bad days.

One day I decided I would quit cold turkey. (Keep reading to learn a better method!) It went surprisingly well, although my migraine situation did not change too much. However, when I moved back in with my parents the following summer. They brew a large pot of coffee every morning, which was simply too tempting for me!

Years later, my migraine had spiraled even further out of control. I decided, once again, that coffee had to go. I slowly tapered off of it (stay tuned to if you want to know how!) and enjoyed feeling less reliant on it. Yet, it still didn’t seem to help my migraine situation.

I asked my neurologist for advice, and she recommended I keep it in my life since it helps (and doesn’t seem to hurt) but limit it to about 4 days per week.

I’ve followed this recommendation, trying to only indulge every other day. It doesn’t always work, especially if I’m dealing with a long painful flare, but one of my biggest lessons from chronic migraine is to give myself grace. 

I allow myself to give myself what brings me comfort and peace, then move forward when I’m able to. Reread that sentence if you need to!

Is it addictive?

This is a controversial topic. If you regularly consume caffeine, it can feel like you “need” it. The fact that caffeine withdrawal is a real clinical condition with uncomfortable symptoms certainly makes a case for caffeine addiction. However, the American Psychiatric Association doesn’t consider caffeine addiction as a substance use disorder. A dependence on caffeine is a more accurate name.

Caffeine tolerance & how to taper off

The best way to determine how caffeine impacts your migraine is to see how you do without it and reintroduce it slowly. I know this can be frustrating if you’re a huge coffee lover like myself, (or lover of another caffeine source,) but stick with me.

Even if caffeine is something you know to be helpful, having it regularly decreases its helpful impact. I’ve found personally that it treats my migraine attacks way more effectively now than when I had it every day.

For people with a history of severe or chronic migraine, it is recommended to cut caffeine out entirely for several months.

The best way to “quit” caffeine is to do it SLOWLY. Caffeine withdrawal is very uncomfortable and can temporarily worsen migraine. If your caffeine of choice is coffee, below is a guide to taper off.

I recommend finding a pace that works for you, whether you want to be off of caffeine within a week or if you’re able to stretch it out to a month (or longer).

What you’ll need:

  • Caffeinated coffee
  • Decaffeinated coffee
  • Regular add-ins

What you’ll do:

  • 100% caffeinated coffee
  • 75% caff + 25% decaf
  • 50% caff + 50% decaf
  • 25% caff + 75% decaf
  • 100% decaf

Note that decaf still does contain caffeine (only 97% caffeine-free), but I love this method because it is gradual and maintains the ritual of a daily coffee that so many of us treasure.

If you would like to completely cut out caffeine, try tapering down on the amount of decaf over time.

Note that you could utilize Swiss Water Processed decaf coffee, which is 99.9% caffeine-free.

It is best to take several months off of regular caffeine use to see how it impacts you and your migraine disease. When you’re ready to start adding it back, do it slowly and be mindful of how it feels. This is the best way to discover your tolerance.

Summary

So… caffeine and migraine. Friends or foes? We don’t really know!

Like all things with nutrition and migraine, it is all so individualized. If you want support in managing migraine and sifting all the information, I can help. I coach individuals with migraine to manage their disease with Mindfulness, Exercise, Nurture, and Diet – the MEND Method.

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