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Caffeine Withdrawal and Weekend Migraines

May 11th, 2008

Another piece of the puzzle fell in place for me yesterday, as I watched a podcast of Dr. Richard Lipton, professor of Neurology at Albert Einstein College of Medicine, explaining the difference between Migraine & headache.  Thanks to Marijke Durning, R.N. of Help My Hurt for posting the podcast in The Difference between Migraine and Headache.  I recommend the podcast as a general explanation of what a migraine is and what sets it aside from an “ordinary” headache.  You might ask your skeptical or uninformed friends and family members to watch it.

The new idea for me had to do with Dr. Lipton’s explanation of the role of caffeine.   I already knew that:

1. caffeine is a vaso-constrictor and so can help treat a migraine attack in progress, by constricting the dilated and inflamed blood vessels around the brain – in fact there are several migraine medications that contain caffeine, such as Cafergot; and
2. caffeine withdrawal can trigger migraine attacks (I have experienced this first hand in a too rapid attempt to get caffeine out of my system).

It is also common for some migraineurs to have smooth sailing during the week, only to be beached by migraines on the weekend, our supposed “time off.”  This happens to me frequently.   Since migraine triggers are “stackable,” we often have to analyze what may be in the stack to figure out what actually triggered the migraine.  Explanations for the weekend migraine include:

1. stress let-down – perhaps the body’s reaction to  a drop in the stress hormones we produce to function during the work week;
2. change in sleep pattern – a trigger for many migraineurs who find we need to keep our bed-times and waking times as regular as possible to avoid migraines;
3. change in eating patterns on the weekend – if you eat much later than usual, your body may
   interpret it as missing a meal! (I have found that I need to get up and feed myself on a Saturday morning to avoid a migraine.  No waiting for Danny to get up and cook one of his weekend breakfast feasts – I can’t enjoy my Oeufs beurre noir if I’ve already gotten a migraine waiting for him to get up!); and
4. I suspect that if you take medications and supplements at the same time in the morning five days a week and then vary that time on the weekend, this too messes with your migraineur’s sensitive brain.

But here’s the new idea (you’ve probably guessed it by now) – if you have a cup of coffee at 6:30 a.m. Monday through Friday, and you sleep in until 9 on Saturday, what do you wake up into?  Caffeine withdrawal!  If your brain is habituated to caffeine at a particular time and doesn’t get it, the addictive little critter (i.e. your brain) starts screaming for its cup of Joe while you’re still sleeping!   Add this factor to the others discussed above and you’re in for a weekend of pain!

I’m not sure what the solution is here – I know, I know, get up at the same time every day.  I’m still very resistant to the idea, although I have to confess I can’t sleep past about 8:00 on weekends any more.  Perhaps an IV caffeine drip at 7 a.m. – nah – no sleeping in that way!  Cut out morning caffeine entirely – radical notion!

Dr. Lipton recommends limiting caffeine to one cup per day, and using more to treat migraines when they arise.  I am going to give this a try.  And I will have my one cup per day after lunch!  If you decide to try is as well, a word of advice.  To avoid withdrawal migraines, cut your caffeine back very gradually.  If you have 3 cups in the morning, cut back to 2 1/2 for at least 3 or 4 days.  Then cut back to 2… You get the picture.

Happy Mother’s Day all you moms out there!  I am about to be served my breakfast in bed.  (I got up at 8 and had toast and coffee.  This one is for the ritual of it.)  Wishing everyone a pain free day.

– Megan
Caffeine addict, heading back on the wagon.  Trying not to repeat yesterday’s weekend migraine!

Cup of Coffee image courtesy of Tammy Green; Breakfast image courtesy of Ian Rotea; Alarm Clock image courtesy of Chris Metcalf

Tags: caffeine addiction, caffeine withdrawal, Dr. Richard Lipton, Migraine trigger, Mother's Day, stackable trigger, vaso-constrictor, weekend migraine
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