Three or more caffeinated drinks could trigger migraines

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MigraineA study by researchers at Beth Israel Deaconess Medical Center (BIDMC), Brigham and Women’s Hospital and the Harvard TH Chan School of Public Health (HSPH) evaluated the role of caffeinated beverages as a potential trigger of migraine. Led by Dr Elizabeth Mostofsky, an investigator in BIDMC’s Cardiovascular Epidemiology Research Unit and a member of the department of epidemiology at HSPH, researchers found that, among patients who experience episodic migraine, one to two servings of caffeinated beverages were not associated with headaches on that day, but three or more servings of caffeinated beverages may be associated with higher odds of migraine headache occurrence on that day or the following day.

“While some potential triggers – such as lack of sleep – may only increase migraine risk, the role of caffeine is particularly complex, because it may trigger an attack but also helps control symptoms,” said Mostofsky. “Caffeine’s impact depends both on dose and on frequency, but because there have been few prospective studies on the immediate risk of migraine headaches following caffeinated beverage intake, there is limited evidence to formulate dietary recommendations for people with migraines.”

In their prospective cohort study, Mostofsky and colleagues – including principal investigator Dr Suzanne M Bertisch, of the division of sleep and circadian disorders at Brigham and Women’s Hospital, Beth Israel Deaconess Medical Centre, and Harvard Medical School – 98 adults with frequent episodic migraine completed electronic diaries every morning and every evening for at least six weeks. Every day, participants reported the total servings of caffeinated coffee, tea, soda and energy drinks they consumed, as well as filled out twice daily headache reports detailing the onset, duration, intensity, and medications used for migraines since the previous diary entry. Participants also provided detailed information about other common migraine triggers, including medication use, alcoholic beverage intake, activity levels, depressive symptoms, psychological stress, sleep patterns and menstrual cycles.

To evaluate the link between caffeinated beverage intake and migraine headache on the same day or on the following day, Mostofsky, Bertisch and colleagues used a self-matched analysis, comparing an individual participant’s incidence of migraines on days with caffeinated beverage intake to that same participant’s incidence of migraines on days with no caffeinated beverage intake. This self-matching eliminated the potential for factors such as sex, age, and other individual demographic, behavioural and environmental factors to confound the data. The researchers further matched headache incidence by day of the week, eliminating weekend versus week day habits that may also impact migraine occurrence.

Self-matching also allowed for the variations in caffeine dose across different types of beverages and preparations. “One serving of caffeine is typically defined as eight ounces or one cup of caffeinated coffee, six ounces of tea, a 12-ounce can of soda and a 2-ounce can of an energy drink,” said Mostofsky. “Those servings contain anywhere from 25 to 150 milligrams of caffeine, so we cannot quantify the amount of caffeine that is associated with heightened risk of migraine. However, in this self-matched analysis over only six weeks, each participant’s choice and preparation of caffeinated beverages should be fairly consistent.”

Overall, the researchers saw no association between one to two servings of caffeinated beverages and the odds of headaches on the same day, but they did see higher odds of same-day headaches on days with three or more servings of caffeinated beverages. However, among people who rarely consumed caffeinated beverages, even one to two servings increased the odds of having a headache that day.

“Despite the high prevalence of migraine and often debilitating symptoms, effective migraine prevention remains elusive for many patients,” said Bertisch. “This study was a novel opportunity to examine the short-term effects of daily caffeinated beverage intake on the risk of migraine headaches. Interestingly, despite some patients with episodic migraine thinking they need to avoid caffeine, we found that drinking one to two servings/day was not associated with higher risk of headache. More work is needed to confirm these findings, but it is an important first step.”

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

Abstract
Objective: We aimed to evaluate the role of caffeinated beverage intake as a potential trigger of migraine headaches on that day or on the following day.
Methods: In this prospective cohort study, 101 adults with episodic migraine completed electronic diaries every morning and evening. Ninety-eight participants completed at least 6 weeks of diaries in March 2016-October 2017. Every day, participants reported caffeinated beverage intake, other lifestyle factors, and the timing and characteristics of each migraine headache. We compared a participant’s incidence of migraines on days with caffeinated beverage intake to the incidence of migraines among the same individual on days with no intake, accounting for day of week. We used conditional logistic regression to estimate odds ratios (OR) and 95% confidence intervals.
Results: Among 98 participants (86 women, 12 men) with mean age 35.1 years, 83% white, and 10% Hispanic or Latino, the average age when headaches started was 16.3 years. In total, the participants reported 825 migraines during 4467 days of observation. There was a statistically significant nonlinear association between the number of caffeinated beverages and the odds of migraine headache occurrence on that day (P-quadratic trend = .024), though estimates for each level of intake were not statistically significant. The associations varied according to habitual intake and oral contraceptive use.
Conclusions: There was a nonlinear association between caffeinated beverage intake and the odds of migraine headache occurrence on that day. This suggests that high levels of caffeinated beverage intake may be a trigger of migraine headaches on that day.

Authors
Elizabeth Mostofsky, Murray A Mittleman, Catherine Buettner, Wenyuan Li, Suzanne M Bertisch

Beth Israel Deaconess Medical Centre material
American Journal of Medicine abstract


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