Consumption of more than 3 cups of coffee a day may trigger migraine attack

Consumption of more than 3 cups of coffee a day may trigger a migraine attack. The new study links high daily intake of caffeinated beverages with the onset of migraine headaches on the same or next day.

Researchers at Beth Israel Deaconess Medical Center (BIDMC), Brigham and Women's Hospital and the Harvard T.H. Chan School of Public Health (HSPH) have found that 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. The study has been published in The American Journal of Medicine.

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

"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.

Approximately 87 per cent of Americans consumes caffeine daily, with an average intake of 193 mg per day. Whereas some behavioural and environmental factors may only have potentially 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.

"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.