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From the Archives: Caffeine & Headaches

This post is from September 29, 2006.

Caffeine is often cited as a headache trigger, but it can be an effective abortive too. Many headache medicines even contain caffeine. Some books say to avoid caffeine at all costs, others warn that you not go over two cups a day.

As with every other headache treatment, it seems, the answer lies in your knowledge of your body. For years I thought my headaches were caused by withdrawal. Turns out I just have chronic daily headaches and caffeine reduces the pain.

I can drink caffeine daily without apparent ill effects, but I prefer to save it to use as a headache abortive. For many other people, drinking it regularly triggers headaches.

Part of finding the right balance between a helpful level and an excessive amount is figuring out just how much caffeine you consume. There are charts of caffeine levels in foods and drinks, but the solution is murkier than it seems.

  • Sensitivity varies widely from one person to the next. Researchers attribute this to genetics and weight.
  • Consuming caffeine right after eating a meal can slow down its effect.
  • Nicotine is thought to stimulate enzymes that break caffeine down, so smokers can often tolerate higher doses of caffeine.
  • Espresso doesn’t have more caffeine than drip coffee; it just has a stronger taste.
  • Coffee and espresso at Starbucks have a higher caffeine content than what you make at home or get at a fast food restaurant or another coffeehouse.
  • Chocolate has more caffeine than you think it does (at least more than I thought it did).
  • Green tea has less caffeine than black tea. White tea has even less.

I was only able to figure out my body’s relationship to caffeine by going off it. My strategy is to gradually decreasing the amount that I drank until I was caffeine-free. (Some people go cold turkey, but that’s more misery than I care to bear. The nasty withdrawal headache can last from a few days to several weeks.) After that I played around with different levels of consumption.

What are your experiences with caffeine? Does it help, hurt or is it somewhere in between?

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Enough is Enough: Rebound Headaches

News anchors, journalists and medical websites have warned that “painkillers might be causing your pain!” too many times to count. OK, OK, rebound headaches are nasty; so are chronic daily headaches and migraines. I want to know how much is too much. Not vague amounts, but clear, precise doses.

In comes the conflicting advice. One doctor said to rotate Imitrex, Migranal and Advil every three days to avoid rebounds. Another said that it’s perfectly fine to take a triptan a couple days a week and an OTC painkiller another few days. Of course, no doctor knew just how much Advil I took because I was afraid to admit the amount to myself, much less say it out loud.

When dignity took a backseat to pain relief, I stopped the painkillers. Four years later, I can barely remember how much better I felt when I took occasional painkillers. I often forget that it’s even an option. But I do remember my headache specialist telling me that the goal of my treatment is to make me feel like I do when I take Advil*. Lately, the forbidden drug has started calling my name.

Because my headache specialist, who I think is terrific, relies on the International Headache Association’s standards, I’ll do the same. IHS’s bottom line is that rebounds are likely if you take painkillers or migraine abortants more than once or twice a week or more than 10 times a month. As you well know, nothing is one size fits all, but these are good guidelines.

Think you might be in rebound? Here are some frequently prescribed meds that can cause rebound headaches. You’ll be miserable if you stop them cold turkey, so get your doc’s advice first.

Triptans: Amerge, Axert, Frova, Imitrex, Maxalt, Relpax, Zomig

Ergots: Cafergot, D.H.E. 45, Migranal, Sansert

OTC Painkillers: Acetaminophen (Tylenol, Excedrin, Vanquish), Asprin (Bayer, Bufferin), Ibuprofen (Advil, Motrin), Naproxen Sodium (Aleve)

Prescription NSAIDs: Indomethacin (Indocin), Ketorolac Tromethamine (Toradol), Naproxen Sodium (Anaprox, Naprelan, Naprosyn), Piroxicam (Feldene)

Opioids: Fentanyl (Duragesic, Actiq), Hydrocodone (Vicodin, Lortab, Lorcet, Norco), Morphine (MSIR, MS Contin, Oramorph), Oxycodone (Roxicodone, OxyContin, OxyFast, OxyIR)

The scariest part about stopping the meds is that your headaches might not change or may even worsen.The underlying condition that prompted you to take them in the first place is probably still there. Even if you don’t get immediate relief, your headaches may be easier to treat in the long run with fewer drugs getting in the way. And your kidneys will thank you.

*Advil doesn’t get rid of my headaches, but it sometimes reduces the severity of the pain. For me, feeling “much better” is having pain that’s below threshold that would keep me in bed.