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

Abstract

Migraine is a chronic disorder, and caffeine has been linked with migraine for many years, on the one hand as a trigger, and on the other hand as a cure. As most of the population, including migraineurs, consume a considerable amount of caffeine daily, a question arises as to whether it influences their headaches. Indeed, drinking coffee before a migraine attack may not be a real headache trigger, but a consequence of premonitory symptoms, including yawning, diminished energy levels, and sleepiness that may herald a headache. Here, we aim to summarize the available evidence on the relationship between caffeine and migraines. Articles concerning this topic published up to June 2020 were retrieved by searching clinical databases, and all types of studies were included. We identified 21 studies investigating the prevalence of caffeine/caffeine withdrawal as a migraine trigger and 7 studies evaluating caffeine in acute migraine treatment. Among them, in 17 studies, caffeine/caffeine withdrawal was found to be a migraine trigger in a small percentage of participants (ranging from 2% to 30%), while all treatment studies found caffeine to be safe and effective in acute migraine treatment, mostly in combination with other analgesics. Overall, based on our review of the current literature, there is insufficient evidence to recommend caffeine cessation to all migraine patients, but it should be highlighted that caffeine overuse may lead to migraine chronification, and sudden caffeine withdrawal may trigger migraine attacks. Migraine sufferers should be aware of the amount of caffeine they consume and not exceed 200 mg daily. If they wish to continue drinking caffeinated beverages, they should keep their daily intake as consistent as possible to avoid withdrawal headache.

Chronic migraine in the first COVID-19 lockdown: the impact of sleep, remote working, and other life/psychological changes

“…Migraine represents a social problem with an enormous disability burden, especially in chronic migraine (CM) [ 1 , 2 ]. It is influenced by life style and habits such as coffee consumption [ 3 , 4 ], smoke [ 5 ], computer, smartphone, and television use [ 6 ]. Sleep quality (SQ) [ 7 , 8 ], depression, anxiety, and stress [ 4 ] have also a significant impact.…”

Hubungan antara Migrain dan Kafein

“…7 Dalam perannya pada manajemen nyeri kepala (migrain), kafein secara luas digunakan sebagai ajuvan karena dapat meningkatkan efektivitas obat-obat yang digunakan untuk mengobati migrain. 8 Individu yang sudah lama mengonsumsi kafein seperti orang yang gemar minum kopi atau orang yang setiap bekerja selalu mengonsumsi kafein (misalnya dalam bentuk kopi atau minuman berenergi) biasanya akan mengalami efek toleransi kafein sehingga harus mengonsumsi jumlah kafein yang lebih banyak dibanding sebelumnya untuk mencapai efek yang sama. Individu yang tidak mengonsumsi kafein dalam rentang waktu tertentu akan mengalami gejala-gejala seperti mengantuk dan lemas.…”

“…Aura yang ditimbulkan saat terjadi vasokonstriksi juga makin memperkuat hasil penelitian bahwa kafein lebih erat hubungannya dengan migrain dibanding nyeri kepala tipe tegang. 7,8 Gejala putus kafein atau caffeine withdrawal symptoms umum terjadi pada individu yang sudah mengalami adaptasi toleransi karena mengonsumsi kafein secara kronis sehingga ketidakhadiran kafein dalam tubuh dapat memunculkan gejala seperti migrain. 8,9 Penelitian Alstadhaug et al 13 yang meneliti 17 subjek yang sudah mengalami migrain dan mengonsumsi kafein ≥300 mg sampai ≤800 mg setiap hari selama minimal satu bulan, menemukan bahwa terdapat subjek yang meneruskan konsumsi kafeinnya dan ada yang menghentikan.…”

“…Bila individu tersebut menghentikan konsumsi kafeinnya maka adenosin yang berikatan akan jauh lebih banyak sehingga dapat terjadi vasodilatasi berlebihan yang akan mencetuskan respons nyeri. 8 Selain menjadi salah satu faktor pencetus migrain, kafein juga dapat meredakan nyeri kepala akibat migrain karena efek dari kafein itu sendiri yang menyebabkan vasokonstriksi pembuluh darah otak. Melalui penelitian Baratloo (Tabel 4), dapat dilihat bahwa walaupun kelompok yang mendapat pengobatan dengan kafein sitrat intravena tidak lebih efektif dibandingkan dengan kelompok yang mendapat pengobatan dengan MgSO4 intravena dalam menurunkan nyeri kepala akibat migrain, namun pada penelitian ini kafein terbukti dapat menurunkan nyeri kepala akibat migrain dengan adanya penurunan skor VAS pada kelompok yang mendapat pengobatan kafein sitrat intravena.…”

Antioxidant and Neuroprotective Effects of Caffeine against Alzheimer’s and Parkinson’s Disease: Insight into the Role of Nrf-2 and A2AR Signaling

“…Conversely, studies have shown that caffeine may cause migraine and affect the quality of sleep, mainly by activating the brain system [163]. The side effects and dosing frequency have not been fully established, so a clearer understanding and exploration are needed.…”