Caffeine and Primary (Migraine) Headaches—Friend or Foe?

Abstract

Background: The actions of caffeine as an antagonist of adenosine receptors have been extensively studied, and there is no doubt that both daily and sporadic dietary consumption of caffeine has substantial biological effects on the nervous system. Caffeine influences headaches, the migraine syndrome in particular, but how is unclear.Materials and Methods: This is a narrative review based on selected articles from an extensive literature search. The aim of this study is to elucidate and discuss how caffeine may affect the migraine syndrome and discuss the potential pathophysiological pathways involved.Results: Whether caffeine has any significant analgesic and/or prophylactic effect in migraine remains elusive. Neither is it clear whether caffeine withdrawal is an important trigger for migraine. However, withdrawal after chronic exposure of caffeine may cause migraine-like headache and a syndrome similar to that experienced in the prodromal phase of migraine. Sensory hypersensitivity however, does not seem to be a part of the caffeine withdrawal syndrome. Whether it is among migraineurs is unknown. From a modern viewpoint, the traditional vascular explanation of the withdrawal headache is too simplistic and partly not conceivable. Peripheral mechanisms can hardly explain prodromal symptoms and non-headache withdrawal symptoms. Several lines of evidence point at the hypothalamus as a locus where pivotal actions take place.Conclusion: In general, chronic consumption of caffeine seems to increase the burden of migraine, but a protective effect as an acute treatment or in severely affected patients cannot be excluded. Future clinical trials should explore the relationship between caffeine withdrawal and migraine, and investigate the effects of long-term elimination.

Sudden Caffeine Withdrawal Triggers Migraine—A Randomized Controlled Trial

“…As suggested by Spencer (38), caffeine withdrawal in migraineurs may serve as a human model for studying migraine. Why withdrawal could act as a trigger is unknown, but it is probably a consequence of an up-regulation of adenosine receptors during regular caffeine intake (4). Increased sensitivity to adenosine after withdrawal may increase excitability in networks involved in migraine pathophysiology, lowering the threshold for attacks.…”

“…In healthy adults, cessation of daily doses of as little as 100 mg of caffeine, the equivalent of one cup of coffee, may cause a withdrawal syndrome consisting of headaches, lethargy, and other symptoms (3). Curiously, this syndrome mimics the prodromal phase of migraine, and this seems to have been overlooked when the symptoms of caffeine withdrawal have been investigated (4). Studies explicitly documenting caffeine withdrawal as a trigger for migraine seem to be lacking.…”

Secondary Headache: Current Update

“…Moreover, subcortical and lacunar infarctions are the least associated with acute headache compared to cortical strokes 16,17 . Previous studies have reported that vessels in the posterior circulation are more richly innervated by nociceptive afferents than in the anterior circulation 17‐20 . Pain signals from the circle of Willis are transmitted through the trigeminal nerve, whereas vasculature structures of the posterior fossa are innervated by the cervical plexus, vagus, and trigeminal nerve 18,20,21 .…”

“…Previous studies have reported that vessels in the posterior circulation are more richly innervated by nociceptive afferents than in the anterior circulation 17‐20 . Pain signals from the circle of Willis are transmitted through the trigeminal nerve, whereas vasculature structures of the posterior fossa are innervated by the cervical plexus, vagus, and trigeminal nerve 18,20,21 . Although incompletely understood, the pathophysiology of the headache is presumed to be related to the stimulation of the trigeminovascular afferent system, resulting in the release of vasoactive neuropeptides which mediate subsequent vasodilation 18,20 .…”

The Ambiguous Role of Caffeine in Migraine Headache: From Trigger to Treatment

“…This type of primary headache usually presents with recurrent, typically unilateral and pulsating attacks of severe headaches, lasting from 4 to 72 h, with accompanying symptoms including photophobia, phonophobia, nausea, and vomiting [ 3 ]. Caffeine has been linked with migraine for many years, on the one hand as a trigger, and on the other as a cure [ 4 , 5 , 6 , 7 , 8 ]. As most of the population, including migraine sufferers, consume a considerable amount of coffee and other caffeinated drinks and foods daily, a question arises as to whether it influences their headaches.…”