Does caffeine help migraine attacks or is it a trigger? This is one of the most frequently asked questions of neurologists. The topic of caffeine and migraine is often hotly debated on social media and is usually eye-opening.
In general, caffeine helps the average person with headaches and occasional migraine attacks. They may enjoy a rich cup of coffee each morning to get things going as well as an afternoon pick-me-up. And, some people love to relax after a nice dinner and sip an espresso, cappuccino or cup of decaf. They may notice that their occasional tension headache or even migraine attack vanishes after enjoying a strong cup of coffee. Some people swear by chugging an ice cold Coke or Mountain Dew to fix their raging head pain.
Further supporting caffeine as an effective treatment is the fact that it is not only in many over-the-counter remedies like Excedrin, Anacin, Midol, BC Powder, Goody’s Headache Powder, it’s also in quite a few prescribed medications. Fioricet, Fiorinal, Darvon and Migranal all have caffeine. So, why is caffeine even being questioned? It’s complicated but let’s take a look.
While Migraine Strong writes about the latest in migraine treatments, this is not medical advice. We are patient educators and all information you read should be discussed with your doctor.
The Migraine Brain
The words “average person” are highlighted above. Those of us with frequent, chronic and/or vestibular migraine don’t fit the description of ‘the average person.’ For reasons most likely related to genetics, we have a hyper-responsive brain. Our migraine brain often responds in an abnormal way to normal, routine environmental stimulation in our environment.
For some who may be caffeine-sensitive, foods and drinks with caffeine cause overall irritation and may possibly trigger migraine attacks. It’s often noted that there seems to be a line that is crossed. A little is ok but exceeding the small amount brings on an attack
For others, they may find caffeine helpful or even essential. If you are finding that your migraine attacks are worsening or you are just questioning what else you might be able to do to help yourself, this article is for you.
As a registered dietitian and coffee-lover with a migraine brain, my goal is to help you understand the relationship between caffeine and migraine and how to use it best to help your overall migraine management. The caffeine and migraine connection must be explored.
Four positives for migraine and caffeine as treatment
Ah, this is what you all want to know, eh? You want to know how to keep your precious coffee, tea, soda or energy drink in your life. Or, maybe you are just wondering why your successful migraine medications with caffeine work better than the ones without caffeine.
1. Caffeine’s effect on blood flow in the brain
While there is a conflicting research and theories, caffeine-induces changes in blood flow in different parts of the brain and may help quell a migraine attack.
Migraine as a “vascular event” was the accepted theory long ago but it’s overly simplistic and possibly not a primary factor. Migraine is no longer considered to be strictly a vascular issue and is beautifully explained in this video from the Association of Migraine Disorders about migraine pathophysiology.
Vasoconstriction likely helps some people with migraine but vasodilation is not considered to be the spark in the cascade of activity that brings on our symptoms.
Caffeine, migraine and adenosine
Caffeine may help by blunting the effect of a naturally occurring substance in the brain called adenosine. Adenosine which is present in higher amounts during a migraine attack, is an important neuromodulator. Caffeine likely helps bring relief through vasoconstriction for some of us.
2. Enhanced effects of ingested pain medications
Adenosine and its interaction with caffeine may also explain how analgesics like acetominiphen, aspirin and ibuprofen are boosted when paired with significant doses of caffeine. Doctors noted the added effect of combining caffeine with pain relievers decades ago. Drug manufacturers have given us plenty of over-the-counter options like the ones mentioned earlier.
Another way caffeine (not just in coffee) may speed the absorption of pain medication is that it can increase stomach acidity. The increase may accelerate the digestion and absorption of the pills.
3. Increased gastric motility
Gastric stasis, or slowing of movement in the gastrointenstinal tract is a known symptom of migraine. While this occurs during an attack, it also can occur in the hours before and after the attack is in full-swing. Caffeine stimulates the gastrointenstinal system and can help medications to be properly digested and absorbed. It can also help the nausea and discomfort associated with a GI tract that is sluggish by moving things along.
4. Caffeine and overall wellness
While there are conditions that are worsened by high caffeine consumption, there is evidence that moderate caffeine consumption can be helpful with mood disorders and feeling cognitively sharp and happy.
It is known that people with migraine have higher rates of mood disorders. While migraine does not cause mood disorders and mood disorders do not cause migraine, few would argue that they do feed on each other.
If a cup of steamy coffee, tea or ice cold Coke are part of selfcare and make you feel peaceful or happy, that’s treatment in my book. Personally, coffee (caffeinated and decaf) makes me cheerful. I limit it due to having a migraine brain and am grateful for each sip.
Migraine and caffeine as a trigger
When discussing caffeine as a migraine trigger, it’s important to consider 3 distinct possibilities. Is caffeine a migraine trigger? Is it really withdrawal from caffeine? Or, is the association of the attack following caffeine really just prodrome and not a culprit.
How does caffeine trigger a migraine?
1- Caffeine as a food sensitivity
Caffeine (or perhaps the food/beverage it’s being consumed in) may act like other common food triggers commonly reported like wine, MSG and raw onions.
In the must-read book for all those with migraine, Heal Your Headache by Dr. David Buchholz, Dr. Buchholz refers to caffeine as one of the most potent dietary triggers with a paradoxical effect. He explains that caffeine appears to be helpful in the short run by providing relief but that it increases migraine headaches in the long run. Caffeine is at the top of his list of foods/beverages to avoid.
There are also biochemical reasons that caffeine may act to trigger migraine attacks. Remember our discussion about adenosine above? Caffeine, when “overused,” can decrease two imporant factors for us, magnesium and hydration. Lower magnesium and hydration status make us more vulnerable to exceeding our migraine threshold and having an attack.
Unfortunately, it seems that our migraine brain just over-reacts to factors that people not genetically predisposed to migraine may not even notice.
2- Overuse and withdrawal
Overuse and caffeine withdrawal are arguably the bigger issue in the connection between migraine and caffeine. Dr. Buchholz is specific about it as well as the American Migraine Foundation (AMF). The AMF discourages regular consumption of caffeine and is quite specific about it’s use in their guidelines.
There are also published studies stating that caffeine overuse is a risk factors of migraine chronification. Chronification is when episodic migraine increases in frequency and eventually occurs as headache or migraine on 15 or more days of the month. When this happens for months on end, it becomes more difficult to reverse with medications and lifestyle. Caffeine is just one factor but it’s clearly a controllable one.
In terms of the how and why caffeine is a problem for us relates to our darn migraine brain. It responds to various amounts of caffeine we may consume through the day in foods, beverages and medications. According to Dr. Buchholz, when the caffeine wears off there is a rebound effect that is characteristically headache rather than migraine, but for some people it can progress to migraine. When I was in terrible rebound, my headaches always progressed to a full migraine attack.
3- Is caffeine really a trigger or prodrome?
Some people who have fatigue, yawning, sleepiness or mood changes in the prodrome stage of migraine may often reach for a caffeinated beverage. In this situation, the question of caffeine being a trigger or just an associated beverage can be hard to tease out. When the full attack phase becomes obvious to us, it often seems logical to note a recent increase in caffeine and perhaps wrongly assume caffeine was the culprit.
Caffeine and vestibular migraine
At the ripe old age of 79, my father realized the powerful connection between caffeine and migraine for him. He rarely gets head pain, but he nearly always has a sense of being off-kilter. When he has coffee or caffeinated soda he notices an increase in disequilibrium in short order. Fortunately for him, he was able to enjoy caffeinated coffee for most of his life.
Confirming that caffeine is a common problem for those with vestibular migraine is confirmed by the opinions of 2 “dizzy doctors” whose opinion I often seek. Dr. Timothy Hain is a top doctor in Chicago focusing on the treatment of vestibular disorders. He acknowledges that the topic of caffeine is complicated but recommends limiting caffeine.
Dr. Shin Beh, a neurologist based in Dallas and specializing in VM is passionate about helping people with this underrecognized disease. He recently wrote a book called Victory Over Vestibular Migraine: The ACTION Plan for Healing & Getting Your Life Back. Like Dr. Hain, he uses the word, “complicated,” to describe caffeine and migraine. He advises avoiding it or limiting it to a small consistent amount.
What should YOU do?
Now that you have read about the complicated relationship between caffeine and migraine, what makes the most sense for you?
For those with infrequent attacks
If you are a regular coffee drinker (or other caffeinated beverage), carry on. Just take notice if your attacks increase when you have more caffeine than usual. Remember to consider other sources of caffeine such as over-the-counter and prescribed medications.
Consider that caffeine withdrawal may be the root of your pain. Perhaps you delayed our skipped your normal caffeine dose and your head is staging a revolt. The cure for that is just having some caffeine.
If your attacks are getting more frequent, make an appointment with your doctor and consider weaning from caffeine. As stated before caffeine intake is associated with migraine chronification. You want to avoid that at all costs!
Weaning from caffeine will be a future short article very soon, but in the meantime, plan on slowly reducing your caffeine intake over the course of weeks not days. And please, no cold turkey unless you like to suffer.
For those with frequent attacks or chronic migraine
If you drink caffeinated beverages often and/or take medications with caffeine commonly used to help migraine, you may have ‘rebound headache’ from the caffeine**. It’s also possible that you have rebound from the medication. Yes, the caffeine that used to help your pain may have turned on you. Caffeine acts like medications such as triptans and NSAIDs. They are helpful with infrequent use but can worsen attacks for people prone to migraine.
You will not know if caffeine is a problem for you unless you rid yourself of it and see how you feel. Having been involved with helping many people quit caffeine through our Facebook group for years, a surprising number of people have far fewer attacks and diminished vestibular symptoms when they go without caffeine (and wean properly). I/we highly encourage you to quit caffeine for a few months.
Quitting caffeine has a very nice upside – you will have an additional, natural and readily available abortive therapy to use when you have your next migraine attack. For me, coffee and soda are the only good things about migraine. When using caffeine as an acute migraine remedy, the AMF recommends limiting it to twice per week to avoid rebound and allow it to be effective.
** Important note** If you are using the caffeine-containing medications mention above more than 2-3 days per week for 3 months or more, you are at risk for rebound, or medication-overuse headache. If you are in rebound, this will interfere with your ability to get migraine/headaches in better control. We have more than 4 articles about rebound as it’s very important to understand and not widely recognized by patients and their primary care physicians. Overuse of caffeine and the caffeine containing medications like Excedrin and Fioricet is a signification risk factor in transforming from episodic migraine to chronic migraine.
What about regular use?
Caffeinated beverages can be hard to part with even when you find relief from omitting them from your life. The good news is that unless you have a food sensitivity to the coffee, tea, soda or energy drink, you can likely add a small amount back to your routine. The key is ROUTINE. Most experts will advise you that if you must have daily caffeine, a consistent and low amount each day is the way to do it. Most agree that up to 200mg of caffeine (about 2, 8 ounce cups of coffee) per day is acceptable. The caffeine may even be helpful in the 4 ways described above.
An important tip about using caffeine regularly is to only drink caffeinated beverages in the morning. Sleep is critically important to keep the migraine brain calm and happy and caffeine is known to disrupt healthy sleep.
Caffeine and migraine along with IBS
Is there a link between irritable bowel syndrome (IBS) and migraine? It’s certainly plausible as many people with migraine also have significant gastrointestinal complaints. It’s also possible that these 2 conditions are co-morbidities with no real link between them.
If you have both conditions, reading about the link between coffee and IBS would be helpful in your decision about what’s next for you in trying to figure out how to control both conditions.
If you are interested in reducing your caffeine intake gradually, or you just love coffee, there are decaf coffees that are considered migraine friendly. Swiss Water Processed coffees are decaffeinated with only water so they don’t have a residue of chemicals that have been said to exacerbate migraine. You can also find coffees that are decaffeinated with the CO2 method which leaves no chemical residue. Either of these methods guarantee the coffee to be 99.9% caffeine free. Check out our favorite SWP and CO2 coffee recommendations on our Favorite Products page.
Caffeine is a potent substance. So potent that it can knock out a raging migraine attack.
It’s important to understand YOUR body and how caffeine effects you. The only way to do that is to stop taking it for a few weeks and see what happens. Wouldn’t it be great if you could use it as your main migraine treatment?
And, if you notice that you truly feel better when caffeine is in your life, wouldn’t it be great to “find your dose” and have a daily preventive strategy that is actually enjoyable with pleasant side effects?