Abrupt cessation of caffeine intake is associated with improved treatment of acute migraine, according to results from a small, uncontrolled prospective study published in the Journal of Headache and Pain.
There is conflicting data on the impact of caffeine on migraine. Caffeine has been used to augment acute migraine treatment; however higher levels of caffeine intake have been tied to chronic migraine development. Further, caffeine withdrawal headache is thought to be secondary to rebound cerebral vasodilation that may resolve after 2 weeks.
Mi Ji Lee and investigators from the Department of Neurology at Samsung Medical Center in Seoul, South Korea conducted a prospective, observational study of migraine patients with daily caffeine consumption. Baseline headache related quality of life was evaluated using the headache impact test (HIT-6) and anxiety and depression were evaluated with the Hospital Anxiety and Depression Scale. Patients were instructed to discontinue caffeine intake.
Migraine abortive medications were prescribed at the treating physician’s discretion and included triptans and antiemetics if nausea or vomiting was associated with the migraine headache. Patients were reevaluated at least 2 weeks after caffeine cessation with repeat HIT-6 scores and the migraine assessment of current therapy (migraine-ACT).
The study included 108 participants who reported needing acute migraine treatment on 3 episodes during the follow-up period. Approximately 33% (n=36) of the participants completely abstained from caffeine and tended to have higher HIT-6 scores (P =.018) and a longer migraine history (P =.010). Participants completed the efficacy of treatment assessment in a median of 34.5 days.
Significantly more participants in the abstinence group reported excellent treatment efficacy than in the non-abstinence group (72.2% vs 40.3%, P =.002). Likewise, there was a trend towards improved HIT-6 scores in the abstinence group (n=50, P =.085). Neither group demonstrated differences in headache intensity or monthly headache days reported.
Abstinence from caffeine was independently associated with excellent acute treatment efficacy after multivariate analysis (OR 3.2, 95% CI: 1.2-8.4; P =.018). They found no interaction between acute treatment efficacy and baseline caffeine intake prior to cessation.
Limitations of the study included a non-controlled setting for the prescription of triptans and no assessment of headache exacerbation from caffeine-withdrawal.
“Taken together, our study results might indicate that migraine patients may benefit from complete abstinence of caffeine, similarly to the abrupt discontinuation of acute analgesics for detoxification in patients with medication overuse headache,” the authors concluded.
The authors report no disclosures.
Lee MJ, Choi HA, Choi H, Chung CS. Caffeine discontinuation improves acute migraine treatment: a prospective clinic-based study. J Headache Pain. 2016;17(1):71.