Too much coffee raises the odds of triggering a migraine headache

A new study in The American Journal of Medicine links high daily intake of caffeinated beverages with the onset of migraine headaches on the same or next day


Philadelphia, August 8, 2019

Drinking three or more servings of caffeinated beverages a day is associated with the onset of a headache on that or the following day in patients with episodic migraine, according to a new study in The American Journal of Medicine, published by Elsevier. Results are consistent even after accounting for daily changes in alcohol intake, stress, sleep, physical activity, and menstruation, although there was some variation evident with oral contraception use.

“Based on our study, drinking one or two caffeinated beverages in a day does not appear to be linked to developing a migraine headache, however, three or more servings may be associated with a higher odds of developing a headache,” noted lead investigator Elizabeth Mostofsky, ScD, Cardiovascular Epidemiology Research Unit, Beth Israel Deaconess Medical Center, and Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.

Migraine is a disabling primary headache disorder affecting approximately 1.04 billion adults worldwide and representing the most common pain condition causing lost productivity and significant direct and indirect costs. Despite widespread anecdotal belief that caffeinated beverages may trigger migraine headaches and relieve headaches once they have begun, there is limited scientific evidence to assess the potential association between changes in daily intake and the onset of headaches after accounting for other changes in lifestyle such as physical activity and anxiety. Common anecdotal evidence also suggests that migraine can be immediately triggered by weather or lifestyle factors, such as sleep disturbance and skipping meals.

Approximately 87 percent of Americans consume caffeine daily, with an average intake of 193 mg per day. Whereas some behavioral and environmental factors may only have potential harmful effects on migraine risk, the role of caffeine is particularly complex because the impact depends on dose and frequency. It may trigger an attack, but also has an analgesic effect.

Investigators analyzed data from 98 adults who suffer from episodic migraines. Participants completed electronic diaries twice a day for six weeks reporting on their caffeinated beverage intake, other lifestyle factors, and the timing and characteristics of each migraine headache. The study compared each participant’s incidence of migraines on days they consumed caffeinated beverage intake to the incidence of migraines on days they did not. Baseline data had indicated that participants typically experienced an average of five headaches per month; 66 percent of them usually consumed one to two servings of caffeinated beverages daily, and 12 percent consumed three or more cups. During the six-week study period in 2016-17, participants experienced an average of 8.4 headaches. All reported having caffeinated beverages on at least one day during the study, with an average of 7.9 servings per week.

Line graph showing the association between servings of caffeniated beverages compared to none and occurrence of migrain on the same day.
Association between servings of caffeinated beverages compared to none and occurrence of migraine on the same day among 98 participants with episodic migraines followed for six weeks.

“To date, there have been few prospective studies on the immediate risk of migraine headaches with daily changes in caffeinated beverage intake. Our study was unique in that we captured detailed daily information on caffeine, headache, and other factors of interest for six weeks,” commented Suzanne M. Bertisch, MD, MPH, principal investigator of the study, of the Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA.

These findings suggest that the impact of caffeinated beverages on headache risk was only apparent for three or more servings on that day, and that patients with episodic migraine did not experience a higher risk of migraine when consuming one to two caffeinated beverages per day. Additional research is needed to examine the potential effect of caffeine on symptom onset in the subsequent hours and the interplay of sleep, caffeine, anxiety, environmental factors, and migraine.

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Notes for editors
The article is “Prospective Cohort Study of Caffeinated Beverage Intake as a Potential Trigger of Headaches among Migraineurs,” by Elizabeth Mostofsky, ScD, Murray A. Mittleman, MD, DrPH, Catherine Buettner, MD, MPH, Wenyuan Li, ScD, and Suzanne M. Bertisch, MD, MPH (https://doi.org/10.1016/j.amjmed.2019.02.015). This article appears in The American Journal of Medicine, volume 132, issue 8 (August 2019) published by Elsevier.

This work was conducted with support from the National Institute of Neurological Disorders and Stroke (R21-NS091627), the American Sleep Medicine Foundation, Harvard Catalyst/The Harvard Clinical and Translational Science Center (National Center for Advancing Translational Sciences, National Institutes of Health Award UL 1TR002541), and financial contributions from Harvard University and its affiliated academic healthcare centers.

Full text of this article is available to credentialed journalists upon request. Contact Jane Grochowski at +1 406 542 8397 or hmsmedia@elsevier.com to obtain copies. Journalists who would like to interview the authors should contact Lindsey Diaz-MacInnis, Senior Media Relations Specialist, Beth Israel Deaconess Medical Center, at +1 617 667 7372, ldiaz2@bidmc.harvard.edu; Chris Sweeney, Senior Media Relations Manager, Office for External Relations, Harvard T.H. Chan School of Public Health, at +1 617 432 8416, +1 617 549 2638 (mobile), csweeney@hsph.harvard.edu; or Eileen St. Peter, Brigham and Women’s Hospital, at estpeter@bwh.harvard.edu.

About The American Journal of Medicine
The American Journal of Medicine, known as the “Green Journal,” is one of the oldest and most prestigious general internal medicine journals published in the United States. The official journal of The Association of Professors of Medicine, a group comprised of chairs of departments of internal medicine at 125-plus US medical schools, AJM publishes peer-reviewed, original scientific studies that have direct clinical significance. The information contained in this article in The American Journal of Medicine is not a substitute for medical advice or treatment, and the Journal recommends consultation with your physician or healthcare professional. www.amjmed.com

About Elsevier
Elsevier is a global information analytics business that helps scientists and clinicians to find new answers, reshape human knowledge, and tackle the most urgent human crises. For 140 years, we have partnered with the research world to curate and verify scientific knowledge. Today, we’re committed to bringing that rigor to a new generation of platforms. Elsevier provides digital solutions and tools in the areas of strategic research management, R&D performance, clinical decision support, and professional education; including ScienceDirect, Scopus, SciVal, ClinicalKey and Sherpath. Elsevier publishes over 2,500 digitized journals, including The Lancet and Cell, 39,000 e-book titles and many iconic reference works, including Gray's Anatomy. Elsevier is part of RELX, a global provider of information-based analytics and decision tools for professional and business customers. www.elsevier.com

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Elsevier
+1 406 542 8397
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