Abstract
Background: The actions of caffeine as an antagonist of adenosine receptors have been extensively studied, and there is no doubt that both daily and sporadic dietary consumption of caffeine has substantial biological effects on the nervous system. Caffeine influences headaches, the migraine syndrome in particular, but how is unclear.Materials and Methods: This is a narrative review based on selected articles from an extensive literature search. The aim of this study is to elucidate and discuss how caffeine may affect the migraine syndrome and discuss the potential pathophysiological pathways involved.Results: Whether caffeine has any significant analgesic and/or prophylactic effect in migraine remains elusive. Neither is it clear whether caffeine withdrawal is an important trigger for migraine. However, withdrawal after chronic exposure of caffeine may cause migraine-like headache and a syndrome similar to that experienced in the prodromal phase of migraine. Sensory hypersensitivity however, does not seem to be a part of the caffeine withdrawal syndrome. Whether it is among migraineurs is unknown. From a modern viewpoint, the traditional vascular explanation of the withdrawal headache is too simplistic and partly not conceivable. Peripheral mechanisms can hardly explain prodromal symptoms and non-headache withdrawal symptoms. Several lines of evidence point at the hypothalamus as a locus where pivotal actions take place.Conclusion: In general, chronic consumption of caffeine seems to increase the burden of migraine, but a protective effect as an acute treatment or in severely affected patients cannot be excluded. Future clinical trials should explore the relationship between caffeine withdrawal and migraine, and investigate the effects of long-term elimination.
Highlights
It is well-know that caffeine can stimulate wakefulness, increase concentration and decrease the sensation of fatigue [2], but how does it affect one of the most common human agonies [3], headaches? Caffeine is commonly used as analgesic adjuvant for the acute treatment of pain
Caffeine is a major constituent of coffee and tea, and naturally occur in guarana, cola nuts, cocoa, and several other plants [2]
Caffeine passes through all biological membranes, including the blood-brain barrier, and is distributed in all body fluids [18]
Summary
It is well-know that caffeine can stimulate wakefulness, increase concentration and decrease the sensation of fatigue [2], but how does it affect one of the most common human agonies [3], headaches? Caffeine is commonly used as analgesic adjuvant for the acute treatment of pain. Headache can occur independently of the other symptoms [7], and Caffeine-withdrawal headache (Box 2), properly described in the 1940s [8, 9], is recognized as an own diagnostic entity by the International Classification of Headache Disorders (ICHD-3) [10]. Results from both experimental and clinical studies indicate a high rate of caffeine withdrawal in the modern society, that may even be underestimated [5]. The migraine syndrome in particular, but how is unclear
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