Caffeine Withdrawal and Weekend Migraines

Another piece of the puzzle fell in place for me yesterday, as I watched a podcast of Dr. Richard Lipton, professor of Neurology at Albert Einstein College of Medicine, explaining the difference between Migraine & headache.  Thanks to Marijke Durning, R.N. of Help My Hurt for posting the podcast in The Difference between Migraine and Headache.  I recommend the podcast as a general explanation of what a migraine is and what sets it aside from an "ordinary" headache.  You might ask your skeptical or uninformed friends and family members to watch it.   

The new idea for me had to do with Dr. Lipton's explanation of the role of caffeine.   I already knew that:

1. caffeine is a vaso-constrictor and so can help treat a migraine attack in progress, by constricting the dilated and inflamed blood vessels around the brain - in fact there are several migraine medications that contain caffeine, such as Cafergot; and
2. caffeine withdrawal can trigger migraine attacks (I have experienced this first hand in a too rapid attempt to get caffeine out of my system).

It is also common for some migraineurs to have smooth sailing during the week, only to be beached by migraines on the weekend, our supposed "time off."  This happens to me frequently.   Since migraine triggers are "stackable," we often have to analyze what may be in the stack to figure out what actually triggered the migraine.  Explanations for the weekend migraine include:

1. stress let-down - perhaps the body's reaction to  a drop in the stress hormones we produce to function during the work week;
2. change in sleep pattern - a trigger for many migraineurs who find we need to keep our bed-times and waking times as regular as possible to avoid migraines;
3. change in eating patterns on the weekend - if you eat much later than usual, your body may interpret it as missing a meal! (I have found that I need to get up and feed myself on a Saturday morning to avoid a migraine.  No waiting for Danny to get up and cook one of his weekend breakfast feasts - I can't enjoy my Oeufs beurre noir if I've already gotten a migraine waiting for him to get up!); and
4. I suspect that if you take medications and supplements at the same time in the morning five days a week and then vary that time on the weekend, this too messes with your migraineur's sensitive brain.

But here's the new idea (you've probably guessed it by now) - if you have a cup of coffee at 6:30 a.m. Monday through Friday, and you sleep in until 9 on Saturday, what do you wake up into?  Caffeine withdrawal!  If your brain is habituated to caffeine at a particular time and doesn't get it, the addictive little critter (i.e. your brain) starts screaming for its cup of Joe while you're still sleeping!   Add this factor to the others discussed above and you're in for a weekend of pain!

I'm not sure what the solution is here - I know, I know, get up at the same time every day.  I'm still very resistant to the idea, although I have to confess I can't sleep past about 8:00 on weekends any more.  Perhaps an IV caffeine drip at 7 a.m. - nah - no sleeping in that way!  Cut out morning caffeine entirely - radical notion!

Dr. Lipton recommends limiting caffeine to one cup per day, and using more to treat migraines when they arise.  I am going to give this a try.  And I will have my one cup per day after lunch!  If you decide to try is as well, a word of advice.  To avoid withdrawal migraines, cut your caffeine back very gradually.  If you have 3 cups in the morning, cut back to 2 1/2 for at least 3 or 4 days.  Then cut back to 2... You get the picture.

Happy Mother's Day all you moms out there!  I am about to be served my breakfast in bed.  (I got up at 8 and had toast and coffee.  This one is for the ritual of it.)  Wishing everyone a pain free day.

- Megan
Caffeine addict, heading back on the wagon.  Trying not to repeat yesterday's weekend migraine!

                Cup of Coffee image courtesy of Tammy Green; Breakfast image courtesy of Ian Rotea; Alarm Clock image courtesy of Chris Metcalf

Comments

[MaxJerz]

Another thought on cutting down on caffeine - I've seen a suggestion somewhere (can't remember where now) to gradually start mixing decaf in with your regular caffeinated coffee to help cut down. So, if you drink 3 cups of coffee normally, try going down to 2-1/2 regular, 1/2 decaf, then 2 regular, 1 decaf, etc.

I've completely cut caffeine out of my diet, except for chocolate. No more lattes for me. :( I can't tell if caffeine is a trigger or not, but I have enough sleeping problems that introducing caffeine into the picture doesn't really help things.

-MJ

[Barry Spencer]

According to Dr. Lipton caffeine withdrawal is a powerful migraine trigger and a major cause of weekend headache. Why, then, does Dr. Lipton recommend headache patients keep drinking one cup of coffee a day? Why not advise them to eliminate caffeine altogether?

Caffeine indeed constricts blood vessels in the head, but vascular constriction is not the mechanism whereby caffeine relieves migraine. Migraine is not caused by vascular dilation in the head; the vascular theory of migraine has been discarded by headache researchers. And migraine pain surely doesn't originate in the brain, as the brain is insensitive to pain (the brain contains no sensory neurons).

Migraine has never been demonstrated to occur absent caffeine withdrawal. The assumption is that these are two separate and distinct conditions, but the two have never been separated in a scientific trial.

There are many good reasons to believe migraine and caffeine withdrawal headache are one and the same condition. That would readily explain many otherwise mysterious symptoms and aspects of migraine including the major symptoms of migraine, the high prevalence of migraine, the episodic nature of migraine, and the ability of caffeine to abort migraine.

[Megan Oltman]

Barry - I find your comment rather bizarre. How could a genetically based neurological condition which has been described in all human populations throughout human history be one and the same as caffeine withdrawal? Consumption of caffeinated beverages was limited geographically for much of world history.

I have eliminated caffeine from my diet for many months, and still experienced migraines in those periods. I am aware of several other migraine triggers in my life, and many triggers are documented in the medical literature. Some migraineurs have eliminated caffeine entirely, and still experience migraines. The commenter immediately before you is one of these.

Migraine is not always episodic in nature, either. There are many sufferers with chronic Migraine - some of whom have eliminated caffeine in their daunting quest to eliminate the many things that trigger them.

Dr. Lipton mentioned caffeine withdrawal in a discussion of treating migraine attacks. He did not recommend that migraineurs drink a cup of coffee a day, but that they limit their consumption to no more than that amount. Dr. Lipton's comment made a piece of the puzzle fall into place for me, and I hoped it might be helpful to my readers as well.

I concur with the idea that seems to be behind your remarks, that caffeine just ain't good for us. I am clear that I would be better off without it. I am hyper-aware of its addictive quality. It is one of many pieces of our culture that make 21st century living hard for migraineurs. But to say that caffeine withdrawal headache and migraine are one and the same flies in the face of a large body of medical research and practice.

- Megan

[Abi Addison]

My, my, my. If it isn't Barry Spencer, the man who trolls the internet for anything to do with migraines and caffeine.

Migraine is caused by genetics, NOT caffeine.

"Migraine has never been has never been demonstrated to occur absent caffeine withdrawal?" I beg to differ with you, just as I have elsewhere. I have been caffeine-free for over 10 years. I drink no coffee, tea, or soda. Eat no chocolate. I never eat out. Prepare my own meals from organic ingredients. Take NO medications that contain caffeine.

So you don't know what you're talking about. I will quote what someone said to you on one of the forums you tried to invade -- "Why don't you go crawl back under your caffeine-free web site."

Geeze.
Abi

[Bill Lasnick]

I have eliminated caffeine from my life. I did it over a 2 week period to try to minimize withdrawal symptoms. At first I didn't feel much better. In fact, I felt a worse. Caffeine can be effective in nipping a developing migraine as it starts. However, within a few weeks of quitting, I found that I was no longer experiencing the really terrible headaches that would force me to lie down in a darkened room with an ice pack on my head. I still get several migraines a week, but they are not as debilitating. Quiting caffeine is not a cure, but it helps. However, when your trying to quit, give yourself time. Don't quit 'cold turkey' and don't expect an immediate improvement.

[Megan Oltman]

Good for you, Bill! I too have virtually eliminated caffeine in the month and a half since I posted this. And I've had fewer migraines in that time! I do still use it to help abort a migraine in its early stages. I'm glad it helped you.