Coffee and migraine are a complex relationship

Coffee and migraine can have a complex relationship, and in some people, caffeine can affect migraine symptoms. Here are some aspects of the relationship between caffeine and migraine:

1. Caffeine as a migraine provocateur: Consumption of large amounts of caffeine may be associated with migraine headaches. In some people, migraines may be caused by dilation and subsequent constriction of blood vessels in the head, and caffeine can affect vascular tone. As a result, migraine symptoms can occur when large amounts of caffeine are consumed.
2. Caffeine as a migraine medication: In some people, caffeine may help manage migraine. Caffeine is often included in many migraine medications, as it can help the absorption of other drug components and reduce the vasodilation associated with migraine. However, prolonged and excessive caffeine consumption can lead to tolerance and worsening of migraine symptoms in the future.
3. Caffeine withdrawal and migraine: When caffeine is addictive and high doses are consumed regularly, caffeine withdrawal can cause withdrawal symptoms, which can include headaches and other symptoms including migraine. This can create a sense of dependence on caffeine.
4. Individual sensitivity: It is important to note that the response to caffeine and its effects on migraine can be individualized. The amount of caffeine that causes side effects can vary and depends on a person's weight and gender, the presence of hypertension and liver disease, and metabolic induction and inhibition of cytochrome P-450. [1] The level of sensitivity to caffeine varies from person to person, and what will trigger migraine symptoms in one person may not have the same effect on another.

Since the structure of caffeine is similar to adenosine, it acts through non-selective antagonism to adenosine A1 and A2A receptors, causing their inhibition. Importantly, adenosine is an inhibitor of neuronal activity in the nervous system; its receptors have been reported to be involved in antinociception, and their enhancement can lead to arousal, concentration, and alertness. However, caffeine does not affect dopamine release and therefore has no potential for abuse. In humans, after oral administration, caffeine is rapidly and completely absorbed (maximum t 30-120 min) and freely penetrates the blood-brain barrier. Although the main component of coffee is caffeine, it should be noted that it is a complex beverage comprising more than 1000 compounds, most of which have not yet been identified. [2]

How does caffeine affect the blood vessels of the brain?

Moderate daily caffeine consumption (300-400 mg, about 4-5 cups of coffee) is reported to be safe and does not cause any health problems (except in pregnant women and children). [3]

The effect of caffeine on blood flow and arteries remains controversial. On the one hand, there is evidence that caffeine reduces the production of nitric oxide (NO, responsible for vascular dilation) by endothelial cells, and on the other hand, a number of studies have shown an increase in NO production after caffeine administration. [4], [5] Several studies have examined the direct effects of caffeine on endothelial function and concluded that caffeine enhances and improves endothelium-dependent but not endothelium-independent vasodilation, suggesting that it does not affect vascular smooth muscle function. [6], [7] The reason for this ambiguous effect, termed the "caffeine paradox," may be the different effects of caffeine on endothelium and smooth muscle. Caffeine is known to be an antagonist of adenosine receptors. Interestingly, adenosine via adenosine A2A receptor stimulates NO production with further vasodilation, but in contrast, via adenosine A1 receptor, adenosine decreases NO release and causes vasoconstriction. Thus, depending on the binding affinity of caffeine and dose, it can cause either vasoconstriction or vasodilation, and sometimes it may not even alter vascular function It is important to note that methylxanthines such as caffeine usually cause vasodilation except in the central nervous system, where they increase cerebrovascular resistance (CVR) and decrease cerebral blood flow (CBF).

Thus, the effects of caffeine on cerebral blood vessels can be twofold, depending on the concentration and sensitivity of the body:

1. Vasoconstriction: Caffeine can temporarily constrict the blood vessels of the brain (vasoconstriction) at low concentrations. This can reduce blood flow in some brain vessels and possibly relieve some types of headaches. For example, caffeine is sometimes included in migraine medications to enhance the vasoconstrictor effects of other components.
2. Vascular relaxation: In high doses or in some people, caffeine can cause relaxation of the blood vessels in the brain, causing them to dilate (vasodilation). This can increase blood flow to the brain, improving brain function, but may also be associated with an increase in blood pressure. Also, higher doses can cause restlessness, nervousness, headache, drowsiness, nausea, insomnia, tremors, tachycardia, and increased blood pressure. [8]

In most people, moderate caffeine intake (e.g., in the form of a cup of coffee) does not cause serious effects on the blood vessels of the brain and does not lead to head pain. However, in some people, high doses of caffeine or sensitivity to caffeine can cause headaches, such as when too much caffeine is consumed in a short period of time (caffeine intoxication) or when caffeine use is abandoned after addiction (caffeine withdrawal syndrome).

Effects of caffeine on pain and non-migraine headaches

There is evidence that caffeine can reduce pain sensation by acting on adenosine receptors. [9] The antinociceptive effects of caffeine can be attributed to inhibition of cyclooxygenase activity as well as antagonism to adenosine receptors. Caffeine acts not only by central blockade of adenosine receptors, which affects the transmission of pain signals, but also by blocking peripheral adenosine receptors on sensory afferents. It has been demonstrated that a 200 mg dose of caffeine can inhibit the analgesic effect of percutaneous electrical nerve stimulation. [10]

Caffeine as a treatment for migraine

Although caffeine has been used for migraines for many years, its effectiveness was initially attributed to its vascular properties. Because caffeine causes cerebral vasoconstriction, it was thought that by this mechanism it could stop a migraine attack. However, the role of vasodilation in migraine is unclear, and recent evidence casts doubt on its necessity. [11] It is now known that migraine is a neurologic rather than a vascular disease, so the therapeutic effect of caffeine appears to go beyond its vascular effects. Adenosine has been reported to be one of the neuromodulators that contribute to the pathophysiology of migraine. First of all, plasma adenosine levels increase during migraine attacks, and exogenous adenosine can induce migraine headaches. [12] In addition, an adenosine uptake inhibitor (dipyridamole) can increase the frequency of migraine attacks. Finally, because caffeine competitively counteracts the effects of adenosine by binding to some of the same receptors, it may be effective in treating migraine. [13]

Caffeine as a migraine trigger

Triggers are events or exposures that increase the likelihood of an attack within a short period of time. [14] The 10 most common migraine triggers are stress; fatigue; hunger; auditory, visual, and olfactory triggers; hormonal triggers; sleep; weather; and alcohol. [15] Dietary triggers are less common and include chocolate, coffee, red wine, nuts, cheese, citrus fruits, processed meats, monosodium glutamate, and aspartame. [16] It is possible that an isolated trigger is not enough to trigger a migraine attack, so migraine sufferers usually recognize several dietary triggers. [17] Caffeine can act as a trigger in two possible ways: drinking coffee or other caffeinated beverages can trigger a migraine attack, and caffeine withdrawal is an even more common migraine trigger. [18], [19] The prevalence of coffee as a migraine trigger in published publications ranges from 6.3% to 14.5%. [20] Moreover, caffeine abuse is one of the risk factors for migraine chronicity, thus contributing to the transformation of episodic migraine into its chronic form (when headaches persist ≥15 days per month for >3 months). [21], [22] Importantly, caffeine intake was not significantly associated with medication overuse in patients with chronic migraine. [23] The question arises: what is the exact mechanism by which caffeine may cause migraine? First, caffeine causes loss of magnesium in the urine, probably by reducing its reabsorption. [24] Because magnesium affects neuromuscular conduction and nerve transmission and plays a beneficial role in chronic pain and migraines, caffeine, by reducing magnesium levels, may cause headaches. [25] Dehydration is one possible migraine trigger. [26] Caffeinated coffee at higher doses causes an acute diuretic effect and may subsequently lead to dehydration. [27] Courtier et al. Linked weekend migraine attacks to caffeine withdrawal. In their study, patients with high daily caffeine intake on weekdays and reduced or delayed caffeine intake on weekends (due to prolonged sleep) had an increased risk of weekend headaches. Thus, the observed higher incidence of weekend migraines may be related to caffeine withdrawal. [28]

How do you know if caffeine is causing a migraine?

Determining whether caffeine is causing your migraines may require some observation and testing. Here are some steps to help you determine the link between caffeine and migraines:

1. Keep a food journal: Start keeping a food journal to record everything you eat, including foods and drinks that contain caffeine. Also record the dates and times of consumption and migraine onset. This will help you make the connection between caffeine and migraines.
2. Limit caffeine: If you decide to test the effects of caffeine on migraines, start by gradually reducing your caffeine intake. [29] This may include reducing the amount of coffee or other sources of caffeine (carbonated drinks, chocolate, etc.) in your diet.
3. Monitor your response: After you have restricted caffeine for a period of time, continue to record your symptoms in a food journal. Watch for changes in the frequency and intensity of your migraines.
4. Periodic monitoring: If you have fewer or less intense migraines after reducing your caffeine intake, this may indicate a link between caffeine and migraines. If, however, migraines continue to occur regardless of the level of caffeine intake, it is possible that caffeine does not play an important role in your migraines.
5. Consultation with your doctor: If you suspect that caffeine may be related to your migraines, it is recommended that you discuss this with your doctor, especially a neurologist or migraine specialist. Your doctor can help you develop a more specific plan of action and recommend alternatives or treatment if necessary.

Effect of coffee additives on migraine

Coffee additives can affect migraine for different reasons, depending on the ingredients they contain. Migraine is a complex neurological condition, and different factors can trigger attacks in different people. Here are some of the possible effects of coffee additives on migraine:

1. Caffeine: Coffee is one of the most common migraine triggers. Although moderate caffeine consumption can help reduce headaches in some people, too much caffeine or consuming it in excessive doses can trigger or worsen migraine attacks.
2. Sugar: Adding large amounts of sugar to coffee can cause blood sugar levels to spike and then drop dramatically. This may be associated with migraine headaches in some people.
3. Milk and dairy products: For some people, milk and dairy products can be migraine triggers. People with lactose intolerance may be more sensitive to dairy supplements.
4. Spices and flavorings: Some coffee drinks may contain spices and flavorings that can be migraine triggers in some people. For example, cinnamon, vanilla, and other flavorings can trigger a reaction.
5. Artificial additives and preservatives: Additives and preservatives used in coffee drinks can cause sensitivity in some people and trigger migraine attacks.

Recommendations for migraine patients regarding caffeine use

Caffeine intake can have a complex effect on migraine, and its role can vary by individual. Here are some tips that can help manage caffeine use in migraine:

1. Moderate consumption: It is important to watch the amount of caffeine you consume. Moderate caffeine consumption can have a positive effect on some people with migraine, helping to reduce vasodilation and relieve symptoms. It is recommended that you consume no more than 200-400 milligrams of caffeine per day (this is equivalent to about 1-2 cups of coffee).
2. Regular consumption: If you consume caffeine regularly, try to do so at the same time each day. This will help avoid withdrawal symptoms, which can worsen migraine symptoms.
3. Avoid excessive consumption: Too much caffeine can cause vasoconstriction and subsequent dilation, which can be a migraine trigger. Avoid consuming large doses of caffeine.
4. Watch out for foods with caffeine: Caffeine is not only found in coffee, but also in other foods such as tea, carbonated drinks, chocolate and some medicines. Take into account the total amount of caffeine intake from all sources.
5. Pay attention to individual reactions: Reactions to caffeine can be individualized. Some people may find that caffeine helps them manage their migraines, while in others it may make symptoms worse. Watch how your body reacts to caffeine and adjust your intake accordingly.
6. Consult your doctor: If you have frequent migraines and are questioning how caffeine affects your condition, talk to your doctor or a migraine specialist. Your doctor can help you develop a personalized migraine management plan, including incorporating caffeine into your diet.

It is important to remember that each person is unique, and what may work for one may not necessarily work for another. Observing and evaluating your body's response to caffeine can help you make more informed decisions about its consumption for migraine.

Studies examining the effects of coffee on migraine

These studies and reviews look at the effects of caffeine on migraine and headache and provide information on its role as an analgesic and in the onset of migraine. If you are interested in more detailed data and research findings, you can refer to the original source publications.

1. Study: "Caffeine as an analgesic adjuvant in tension headache and migraine: a review" Authors: T. E. Pringsheim, K. A. Davenport, J. E. Mackie et al Year: 2012
2. Study: "Caffeine in the management of patients with headache" Authors: Richard B. Lipton, Walter F. Stewart, et al Year: 2008
3. Study: "Caffeine withdrawal and dependence: a convenience survey among addiction medicine physicians" Authors: Roland R. Griffiths, Laura M. Juliano, John Hughes et al Year: 2013
4. Study: "Caffeine as an analgesic: a review of caffeine mechanisms of action and their clinical implications" Authors: Nina L. Goldstein, Jane R. Cryer Year: 2004
5. The study: "Effect of caffeine on headache in patients with chronic tension-type headache: a randomized controlled trial" Authors: T. E. Pringsheim, W. Gooren, D. M. Ramadan Year: 2014