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Is caffeine good or bad for people who get migraines?

Young, William B.

DEPARTMENTS: Ask the Experts

Dr. William B. Young is an associate professor of Neurology and director of the In-Patient Program at the Jefferson Headache Center in Philadelphia, Pa. He is co-author of Migraines and Other Headaches (American Academy of Neurology Press).

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A: Dr. William B. Young advises:

That's a question with a complicated answer. The key to whether caffeine is harmful or beneficial depends on how much you ingest. (Chocolate contains caffeine, but it does not contain enough to have an effect on headaches.)

Figure. D

Figure. D

We know that caffeine can help migraines. Some people find that a cup of coffee or tea helps relieve an occasional headache or migraine. Caffeine is also used as an ingredient in many commonly used prescription and over-the-counter headache medications.

However, caffeine can also cause headaches. An important study, published in the New England Journal of Medicine about ten years ago, found that people who drank more than one cup of coffee a day were at risk for getting a withdrawal headache if they went without it. This is why people who drink coffee at work on weekdays may develop headaches on the weekends

Also, people who get occasional headaches or migraines and drink more than two cups per day of caffeinated beverages –or who take a lot of medication that contains caffeine – are at risk for developing daily headaches. If you fall into this group, you should gradually cut down on your caffeine intake until it is eliminated. Then you usually will go back to getting only occasional headaches. But you must cut down on the caffeine very gradually or your headaches may worsen.

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