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November 17, 2016

Infrequently Asked Questions: How does caffeine alleviate a migraine?

Few feelings are more satisfying than the moment a migraine fades into the distance as you sip a strong cup of coffee or tea. Consider it one of the more strange forms of pain relief most of us experience.

Curious to know what allows that to happen, we reached out to Stephen Silberstein, director of the Jefferson Headache Center (one of the few headache centers in the country), for some answers. 

What’s happening in the brain with an average headache? That might be a good place to start.

Well, we know more about migraines than anything else. Migraines actually begin in the brain, and as a result of that brain activity, it activates pain fibers from the outside of the brain – they become inflamed and excited, and that’s what causes a migraine and nausea, vomiting and sensitivity to light, sound and odors. Migraines are really a neuro-inflammatory disorder involving the brain and the tissues that surround it.

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And what's the cause?

Here's the issue: We don’t know what the real cause of a migraine is. We know it runs in some families and [there are certain gene types], but in general we don’t know what the cause is of the migraine. We know what triggers migraines and that people with head trauma can develop migraines, but we don’t know the real cause.

What’s the distinction between a headache and a migraine?

OK. So everybody has headaches. But when a headache is severe and throbbing and produces disability, and comes and goes and is overwhelming, it's a migraine. In general, it’s a disabling headache.

And how does caffeine interact with all this? What’s the magic behind it?

Sure. Very important question. There have been studies that show caffeine alone is a pain killer, and that aspirin alone is a pain killer, and the two of them have greater effects [together] than as pain killers [separately]. We know that caffeine works in the brain by multiple mechanisms, and one of those mechanisms is its effect as a pain killer, and another effect is alerting you. So caffeine itself is a pain killer.

 .... [M]any people with migraines feel out of sorts and not sharp, mentally, and so caffeine, as we’re aware, can reverse that.

What’s the chemical process happening?

There’s a chemical in the brain called adenosine. And caffeine interacts with that chemical to produce pain relief.

... Caffeine acts as a stimulant by acting on the adenosine receptor. Adenosine blocks alertness and caffeine reverses this. Blocking adenosine controls pain.

Is there anything overblown about the effects of caffeine on a migraine, or that people maybe misunderstand?

Here’s the problem: If you take caffeine occasionally alone … it relieves pain. If you take caffeine every day of your life – the best example of this is the weekend headache. Everybody drinks several cups of coffee during the week every day, and then on the weekend what happens is they withdraw from it and feel fatigued and tired, and people often have a headache. So caffeine withdrawal produces a headache, and caffeine can relieve a headache. It’s paradoxical. If you take lots of caffeine and you stop, it will make you feel tired and edgy and fatigued, but it also may give you a headache. In contrast, if you take it over time, the addition of caffeine can relieve a migraine headache. So it’s a double-edged sword. That’s the best way of looking at it.

… We have a lot of people who say they get home on the weekend and want to relax and get a headache. And then you ask how much coffee they’re drinking, and they’re drinking too much, and they say they’re enjoying their coffee but the important thing to do is not withdraw over the weekend. Either get a cup of coffee or take some caffeine pills. And how much you take should be based on how much coffee you drink and the caffeine content of your coffee.

They still sell caffeine pills?

There’s a lot of caffeine pills! You can buy them in drug stores and supermarkets, sure.

On their own?

That is correct.

Any research developing on this?

Here’s the issue. We know people who get frequent headaches. When they overuse caffeine, it’s one of the risk factors for them developing daily headaches. Eliminate caffeine consumption on a daily basis and their headaches get better. They get temporarily worsening and then it improves. That’s called medication overuse headache. Like I said, caffeine is a double-edged sword. There are a lot of people out there [who get] a migraine and drink more coffee or consume more caffeine, and then all of a sudden they have worsening headaches [and it no longer works]. 

Now, the same thing can happen if you’re applying medicines too much: They stop working and become part of the problem.

Anything to add?

Yeah, I think that the key to migraines is moderation. Get enough sleep; eat proper meals; if you take coffee, try to limit it to a couple cups a day. And if you get beyond that, unless you need it for special occasions, studying for an exam or up all night and need to function, just try to limit it. I’m not one of those people who thinks you should give up on the fun things in life because you have a migraine. You should be able to do things in moderation and do them very well.

When someone says 'a couple cups,' what does that mean?

I mean two small cups. But more important than that, if you can find out what the content is – if you drink espresso, it’s highly concentrated. It’s an important point to find out what the caffeine content is and try to keep it below 200 milligrams per day. When you get to 500 or 600 milligrams per day, your blood pressure can go up, your pulse can go up and you can have other signs and symptoms. Then again, people who go beyond that, they can become habituated. 

If you're not having a problem – as they say, 'If it ain't broke don’t fix it.' But if your blood pressure rises and you have frequent headaches and you’re anxious, that means that caffeine could be the culprit.

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