Three or more servings of beverages with caffeine may be linked to a greater risk of migraine occurrence on that day or the following day among episodic migraine (EM) patients (those who have up to 14 headache days per month), according to a new study published in the American Journal of Medicine.

Among EM patients who rarely consumed caffeinated beverages, however, even one to two servings increased the odds of having a headache that day.

Migraine is the third most prevalent illness in the world, affecting more than one billion adults worldwide. In addition to severe headaches, symptoms of migraine can include nausea, changes in mood, sensitivity to light and sound, as well as visual and auditory hallucinations.

Migraine patients report that weather patterns, sleep disturbances, hormonal changes, stress, medications, and certain foods or beverages can bring on migraine attacks. However, few studies have looked at the immediate effects of these suspected triggers.

For the study, researchers from Beth Israel Deaconess Medical Center (BIDMC), Brigham and Women’s Hospital, and the Harvard T.H. Chan School of Public Health (HSPH) evaluated the role of caffeinated beverages as a potential trigger of migraine.

Their findings reveal 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 study leader Elizabeth Mostofsky, Sc.D., an investigator in BIDMC’s Cardiovascular Epidemiology Research Unit and a member of the Department of Epidemiology at HSPH.

“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.”

For the study, 98 adults with frequent episodic migraines 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. They also 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.

“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 link 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 principal investigator Suzanne M. Bertisch, M.D., M.P.H., of the Division of Sleep and Circadian Disorders at Brigham and Women’s Hospital, Beth Israel Deaconess Medical Center, and Harvard Medical School.

“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 migraines thinking they need to avoid caffeine, we found that drinking one to two servings/day was not associated with a higher risk of headaches. More work is needed to confirm these findings, but it is an important first step.”

Source: Beth Israel Deaconess Medical Center