Migraine sufferers have long known that certain foods are no-nos when it comes to their neurological well-being. Now Canada’s estimated three million migraine sufferers might want to consider the role of another food — caffeine — but as a treatment for migraine pain.

Experts estimate roughly a third of all migraines are triggered by particular culinary delights, including red wine, aged cheese, cured meat and chocolate. But a recent study, published by U.S.-based Headache: The Journal of Head and Face Pain, in examining the effectiveness of caffeine-enhanced pain relievers vs prescription drugs in the early treatment of migraine, found that certain dosages of caffeine actually treat migraines, not promote them. The study of 171 patients concluded that over-the-counter drugs containing a combination of aspirin, acetaminophen and 130 milligrams of caffeine were “significantly more effective” than the commonly prescribed prescription drug sumatriptan.

That conclusion flies in the face of countless consumer publications and unofficial migraine Web sites that blame caffeine for migraine attacks.

Vancouver-based neurologist and headache specialist Dr. Gordon Robinson says the connection between caffeine and migraines is subtle, and caffeine alone is rarely cited
as a migraine trigger.

“The minority of migraine sufferers will discover that ingesting caffeine will cause a migraine,” he says. Most people don’t need to cut all forms of caffeine out of their diet.
“I’ve seen patients do it and it doesn’t matter at all.”

A migraine is an “inherited instability of the brain” causing debilitating pain on one side of the head, often associated with nausea, vomiting and extreme sensitivity to light and sound. Approximately 20% of migraine attacks are preceded by an “aura,” a period of 30 to 60 minutes in which sufferers experience numbness in the face, slurred speech and visual distortions. Robinson says there has been surprisingly little research into what causes headaches, but doctors have identified a number of foods that can trigger an attack. Other known triggers include changes in barometric pressure, stress, hormonal changes (in women) and lack of sleep.

As for the connection between caffeine and migraines, Robinson says, the Headache study holds true. “For the vast majority of migraine sufferers, ingesting caffeine — either in a pill combined with an analgesic or in [cup of] a coffee — will provide relief from an attack,” he says.

For reasons still not entirely understood, caffeine amplifies the pain-relieving effects of common analgesics such as aspirin and acetaminophen, thus making it an effective co-treatment for any type of pain, he says. With this in mind, major brand-name drug companies such as Excedrin and Tylenol have recently introduced “enhanced” pain-relieving tablets in the Canadian marketplace that combine their usual medicinal ingredients with 65 milligrams of caffeine.

Caffeine has added cachet in the treatment of migraines because it is also a proven vasoconstrictor, which works to decrease swollen blood vessels and inflamed nerve endings, which occur in the brain during a migraine attack.

However, before you pour yourself another cup of coffee, consider Robinson’s warning:
caffeine overuse is a major contributor to chronic daily headaches, a form of migraine caused by ingesting too much caffeine, not only in food format but also in caffeine-enhanced medications intended to treat migraines. “It’s all a part of medication overuse,” he says. “These folks are getting 15 or more headaches a month; they have to stop with the caffeine, and also with the other medication they may be taking.”

But stopping coffee cold turkey is no solution. “The same migraine patient who regularly drinks three or four cups of coffee a day, and then stops, could trigger a pretty mean migraine from caffeine withdrawal,” Robinson says. “And that could happen in people who aren’t usually headache sufferers.”

Although there’s still no cure for migraines, millions of sufferers find relief in any number of treatment options, ranging from simple over-the-counter analgesics (Tylenol, for instance) to codeine, or a family of prescription drugs called triptans, which constrict blood vessels and decrease inflammation. “It’s all about control,” says Robinson. “Proper diagnosis is key, followed by identification and elimination of triggering factors.”

Most doctors will ask patients to keep a “headache calendar” to track migraine attacks, along with associated food and weather changes, hormonal factors, stress levels, etc.
“That gives patients the data to find triggers that are avoidable and stay away from them,” Robinson says.

@page_break@Cold compresses and a massage also help, he adds. IE